NPIMap

Organization Active NPI

Multicare Associates of the Twin Cities,PA

Doing business as Fridley Medical Center

  • Family Medicine Physician
  • Fridley, MN
National Provider Identifier
1275528671
Registry record updated Dec 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35 Issued in MN
Legal business name
MULTICARE ASSOCIATES OF THE TWIN CITIES,PA
Doing business as
Fridley Medical Center
Practice address
480 Osborne Rd NE
Suite 100
Fridley, MN 55432-2773
Phone
(763) 785-4500
Fax
(763) 785-3314
NPI assigned
Sep 13, 2005
Last updated
Dec 29, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
MULTICARE ASSOCIATES OF THE TWIN CITIES, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 29, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Carl Matthew Brandt
Title
Ceo
Phone
(763) 785-7710

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 35 MN Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 35 MN
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X 35 MN
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 35 MN
Occupational Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083X0100X 35 MN

Addresses

Primary practice location

480 Osborne Rd NE
Suite 100
Fridley, MN 55432-2773

Mailing address

480 Osborne Rd NE
Suite 100
Fridley, MN 55432-2773
Phone (763) 785-4500

Other names 1

  • Fridley Medical Center Doing business as

National Provider Directory

National Provider Directory
Part of
Multicare Associates of the Twin Cities PA

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

11855 Ulysses St NE
Ste 110
Blaine, MN 55434
Phone (763) 235-4104

12175 Aberdeen St NE
Minneapolis, MN 55449
Phone (763) 785-4200

480 Osborne Rd NE
Ste 100
Minneapolis, MN 55432
Phone (763) 785-4500

12912 Farnham Ave N
White Bear Lake, MN 55110
Phone (651) 982-7718

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419811200000",
    "number": "1275528671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 OSBORNE RD NE",
            "address_2": "SUITE 100",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322773",
            "telephone_number": "763-785-4500",
            "fax_number": "763-785-3314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 OSBORNE RD NE",
            "address_2": "SUITE 100",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322773",
            "telephone_number": "763-785-4500",
            "fax_number": "763-785-3314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MULTICARE ASSOCIATES OF THE TWIN CITIES,PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MULTICARE ASSOCIATES OF THE TWIN CITIES, PA",
        "enumeration_date": "2005-09-13",
        "last_updated": "2014-12-29",
        "status": "A",
        "authorized_official_last_name": "BRANDT",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "763-785-7710",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "35",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "35",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "35",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "35",
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "MN",
            "license": "35",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fridley Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fridley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.