Allina Health System
Organization Active NPI Family Medicine Physician · Coon Rapids, MN
NPI 1295031649 · NPPES record last updated Jan 21, 2025
Key facts
- NPI
- 1295031649
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ALLINA HEALTH SYSTEM
- Practice address
- 9055 Springbrook Dr NW
Coon Rapids, MN 55433-5841 - Phone
- (763) 780-9155
- Fax
- (763) 236-1312
- NPI assigned
- Feb 2, 2011
- Organization subpart
- No
Authorized official
- Name
- Dominica Tallarico
- Title
- Coo
- Phone
- (612) 222-2222
Practitioners 61
-
Miranda Amaris, MIRANDA
-
Michele Anderson, PMHNP-BC
-
Bruce D Babcock, OD
-
Carley Jean Bacon, PA-C
-
Zehyani Bankwala, M.D.
-
Sarah Anne Bolstad, PAC
-
Julia Kathryn Botzet, C-NP
-
Kelly Mae Chandler, PMHNP
-
Heather J. Crabtree, PH.D.
-
Dawn M Debus, PA-C
-
Brooke Erickson, MD
-
Ashley Fowler, PA-C
-
Matthew Richard Gillott, M.D.
-
Robyn Gunderson, PHD
-
Michael A Hart, MD
-
Laura Hauff, MD
-
Amy Sue Hentges, M.D.
-
Nicole M Hicks, P.A.
-
Leslie Ann Hustvet, DNP, APRN, CNP
-
Dylan H Jackson, PA
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D0402953 | Allina Health Coon Rapids Clinic | Accreditation | Dec 22, 2027 |
| 24D2303222 | Allina Health Coon Rapids Clinic Mohs Lab | Compliance | Jan 13, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in MN
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| St Francis Regional Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest (47.5%) | Nov 15, 2007 |
| Courage Kenny Rehabilitation Institute TRP |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Jun 1, 2013 Jun 1, 2013 |
| Allina Health Restorative Suites |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Nov 10, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
| O20120315000404 | MN | DME Supplier - Physician - Optometrist |
4587573613 | Practice locations: Coon Rapids, MN |
| O20221213001713 | MN | Part B Supplier - Clinic/Group Practice | 4587573613 |
Receives reassigned benefits from 3,000 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Clinic/Center | 261Q00000X | |||
| Urgent Care Clinic/Center | 261QU0200X |
Addresses
Primary practice location
9055 Springbrook Dr NW
Coon Rapids, MN 55433-5841
Mailing address
PO Box 43
Mail Route 10585
Minneapolis, MN 55440-0043
Phone (612) 262-1166
Other practice location 1
11850 Blackfoot St NW Ste 450
Coon Rapids, MN 55433-2773
Phone (763) 236-0800
Other names
- Allina Health Coon Rapids Clinic
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service | Other | Ciox Health |
| CONNECT URL | https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service | Other | Ciox Health |
Other providers in Coon Rapids, MN
- All Hopes Incorporated
- All Star Care
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
All providers in Coon Rapids, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.