NPIMap

Organization Active NPI

Allina Health System

Doing business as Courage Kenny Rehab Associates

  • Physical Medicine & Rehabilitation Physician
  • Minneapolis, MN
National Provider Identifier
1275577215
Registry record updated Jan 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
ALLINA HEALTH SYSTEM
Doing business as
Courage Kenny Rehab Associates
Practice address
800 E 28TH St Ste 1750
Minneapolis, MN 55407-3723
Phone
(612) 863-4495
NPI assigned
Jun 16, 2006
Last updated
Jan 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2025

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

Authorized official

Name
Dominica Tallarico
Title
Coo
Phone
(612) 222-2222

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X Primary
Case Management Agency 251B00000X
Clinic/Center 261Q00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

800 E 28TH St Ste 1750
Minneapolis, MN 55407-3723

Mailing address

PO Box 43
Mail Route 10585
Minneapolis, MN 55440-0043
Phone (612) 262-1166

Other practice location 1

1460 Curve Crest Blvd W
Stillwater, MN 55082-6070
Phone (651) 241-3820

Other practice location 2

3915 Golden Valley Rd
Golden Valley, MN 55422-4249
Phone (612) 775-2455

Other practice location 3

7373 France Ave S Ste 503
Edina, MN 55435-4534
Phone (612) 863-4495

Other names 1

  • Courage Kenny Rehab Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030505000007 MN Part A Provider - Hospital 4587573613 29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20040319000460 MN Part B Supplier - Clinic/Group Practice 4587573613 Receives reassigned benefits from 4,246 practitioners
This NPI is an additional NPI on the enrollment

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275577215. Details of each certification follow.

Hospital certification: CCN 240057

Legal name
ALLINA HEALTH SYSTEM
Doing business as
ABBOTT NORTHWESTERN HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jan 8, 1970
Last certification
Jan 4, 2018
Beds
996 (952 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
800 E 28TH St
Minneapolis, MN 55407-3723
Hospital subgroups
General, Acute care, Other

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 21

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 21

Care Compare: Hospital

Medicare Care Compare
Listed as
Abbott Northwestern HospitalCCN 240057 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

755 Crossroads Campus Dr NE
Buffalo, MN 55313
Phone (763) 684-6300

7373 France Ave S
Ste 503
Edina, MN 55435
Phone (612) 863-4495

280 Smith Ave N
Ste 600
Saint Paul, MN 55102
Phone (651) 241-6550

Ownership & related parties

All disclosed owners & managing parties 26

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Challis Lowe Individual Corporate DirectorBoard Member Jun 8, 2022
John Richard Church Individual Corporate DirectorBoard Member Sep 9, 2021
Laura Jean Gillund Individual Corporate DirectorBoard Member Jun 10, 2015
Amy L Ronneberg Individual Corporate DirectorBoard Member Dec 1, 2020
Daniel Thomas O'Laughlin Individual Corporate DirectorBoard Member Jan 1, 2022
Maykao Y Hang Individual Corporate DirectorBoard Member Jun 13, 2019
David Allan Joos Individual Corporate OfficerPresident Apr 20, 2022
Brian McGrane Individual Corporate DirectorBoard Member Jun 14, 2024
Marna Borgstrom Individual Corporate DirectorBoard Member Jun 13, 2025
Jennifer Soo Alstad Individual Corporate DirectorBoard Member Jun 10, 2016
Shari L Ballard Individual Corporate DirectorBoard Member Jun 10, 2020
Timothy Aloysius Welsh Individual Corporate DirectorBoard Member Dec 1, 2017
Vicki Rasmusen Individual Corporate DirectorBoard Member Jun 13, 2019
Debbra Schoneman Individual Corporate DirectorBoard Member Jun 13, 2013
James Kolar Individual Corporate DirectorBoard Member Sep 13, 2024
Lisa Shannon Individual Corporate DirectorPresident and Ceo Jan 1, 2022
Shawn M Ulreich Individual Corporate DirectorBoard Member Sep 13, 2023
Chanda L Baker Individual Corporate DirectorBoard Member Feb 20, 2024
Melinda Estes Individual Corporate DirectorBoard Member Jun 13, 2025
Louis Julius King Individual Corporate DirectorBoard Member Jun 12, 2017
Ruth Evelyn Williams-Brinkley Individual Corporate DirectorBoard Member Sep 13, 2023
Patricia W Schirmers Individual W-2 Managing EmployeeDirector Reimbursement May 5, 2003
Barbara a Butts Williams Individual Corporate DirectorBoard Member Jun 10, 2015
Thomas S Schreier Individual Corporate DirectorBoard Member Mar 12, 2014
Dominica Marie Tallarico Individual Corporate OfficerCoo Mar 11, 2024
Roger Scott Newcome Individual W-2 Managing EmployeeManager Reimbursement May 6, 2016

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 55

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.

View all 55

Affiliated clinicians 2,935

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 2,935

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736985600000",
    "number": "1275577215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43",
            "address_2": "MAIL ROUTE 10585",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554400043",
            "telephone_number": "612-262-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E 28TH ST STE 1750",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073723",
            "telephone_number": "612-863-4495"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1460 Curve Crest Blvd W",
            "address_purpose": "LOCATION",
            "city": "Stillwater",
            "state": "MN",
            "postal_code": "550826070",
            "country_code": "US",
            "telephone_number": "651-241-3820",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3915 Golden Valley Rd",
            "address_purpose": "LOCATION",
            "city": "Golden Valley",
            "state": "MN",
            "postal_code": "554224249",
            "country_code": "US",
            "telephone_number": "612-775-2455",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7373 France Ave S Ste 503",
            "address_purpose": "LOCATION",
            "city": "Edina",
            "state": "MN",
            "postal_code": "554354534",
            "country_code": "US",
            "telephone_number": "612-863-4495",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ALLINA HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A",
        "authorized_official_last_name": "TALLARICO",
        "authorized_official_first_name": "DOMINICA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "612-222-2222"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Courage Kenny Rehab Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.