Organization Active NPI

Soulspire, LLC

  • Clinic/Center
  • Minnetonka, MN
National Provider Identifier
1316731599
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SOULSPIRE, LLC
Practice address
17508 Minnetonka Blvd
Minnetonka, MN 55345-1007
Phone
(763) 234-4876
NPI assigned
Apr 4, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

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

Authorized official

Name
Dr. Susan Powers Olson
Title
Organizer
Phone
(763) 234-4876

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

17508 Minnetonka Blvd
Minnetonka, MN 55345-1007

Mailing address

17508 Minnetonka Blvd
Minnetonka, MN 55345-1007
Phone (763) 234-4876

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260212000102 MN Part B Supplier - Clinic/Group Practice 0446739171 Receives reassigned benefits from 1 practitioner
Practice locations: Minnetonka, MN

National Provider Directory

National Provider Directory

Locations

17508 Minnetonka Blvd
Minnetonka, MN 55345
Phone (612) 524-8119

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1743724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743724800000",
    "number": "1316731599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17508 MINNETONKA BLVD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553451007",
            "telephone_number": "763-234-4876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17508 MINNETONKA BLVD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553451007",
            "telephone_number": "763-234-4876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOULSPIRE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-04",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A",
        "authorized_official_last_name": "POWERS OLSON",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "ORGANIZER",
        "authorized_official_telephone_number": "763-234-4876",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minnetonka, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.