Prime Family Medical Clinic

Primary specialty

Family Nurse PractitionerTaxonomy code 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

Last updated

May 22, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mindy Lee Kang, NPNPI 1114303831

Title

Ceo/NP

Phone

(651) 219-8583

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

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.

• Mindy Lee Kang, FNP-C.

  • Family Nurse Practitioner
  • North Oaks, MN
  • NPI 1114303831
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1603584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716336000000",
    "number": "1306445853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 VILLAGE CENTER DR STE 800",
            "city": "NORTH OAKS",
            "state": "MN",
            "postal_code": "551277092",
            "telephone_number": "651-219-8583",
            "fax_number": "651-800-9859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 VILLAGE CENTER DR STE 800",
            "city": "NORTH OAKS",
            "state": "MN",
            "postal_code": "551277092",
            "telephone_number": "651-219-8583",
            "fax_number": "651-800-9859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME FAMILY MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-25",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A",
        "authorized_official_last_name": "KANG",
        "authorized_official_first_name": "MINDY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CEO/NP",
        "authorized_official_telephone_number": "651-219-8583",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Sue Pal, C-NP
• Marilynn Poss
• Presbyterian Homes of North Oaks Inc,
• Presbyterian Homes of North Oaks, Inc.
• Prime Chiropractic & Rehab Center
• Anudeep K Rahil, MD
• Brittany Raymond, PHARM.D.
• Roger Lee Rengel, O.D.
• John Salek-Raham, MD DDS
• Josephine Ann Sauro, PA-C

• Family Nurse Practitioner in North Oaks, MN
• Providers in North Oaks, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.