Prime Family Medical Clinic
Organization Active NPI Family Nurse Practitioner · North Oaks, MN
NPI 1306445853 · NPPES record last updated May 22, 2024
Key facts
- NPI
- 1306445853
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- Legal business name
- PRIME FAMILY MEDICAL CLINIC
- Practice address
- 200 Village Center Dr Ste 800
North Oaks, MN 55127-7092 - Phone
- (651) 219-8583
- Fax
- (651) 800-9859
- NPI assigned
- Oct 25, 2020
- Organization subpart
- No
Authorized official
- Name
- Mindy Lee Kang, NP
- Title
- Ceo/NP
- Phone
- (651) 219-8583
Practitioners 1
-
Mindy Lee Kang, FNP-C.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D2202163 | Prime Family Medical Clinic | Certificate of waiver | Nov 24, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201203000446 | MN | Part B Supplier - Clinic/Group Practice | 1052722618 |
Receives reassigned benefits from 1 practitioner Practice locations: North Oaks, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | Yes |
Addresses
Primary practice location
200 Village Center Dr Ste 800
North Oaks, MN 55127-7092
Mailing address
200 Village Center Dr Ste 800
North Oaks, MN 55127-7092
Phone (651) 219-8583
Other providers in North Oaks, MN
- Jacqueline Sue Pal
- Marilynn Poss
- Presbyterian Homes of North Oaks Inc,
- Presbyterian Homes of North Oaks, Inc.
- Prime Chiropractic & Rehab Center
- Anudeep K Rahil
- Brittany Raymond
- Roger Lee Rengel
- John Salek-Raham
- Josephine Ann Sauro
All providers in North Oaks, MN · Family Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 22, 2024. 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.
- 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.