Active NPI
Crystal New Hope Medical Clinic Inc
- Family Medicine Physician
- Crystal, MN
National Provider Identifier
1366628554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- CRYSTAL NEW HOPE MEDICAL CLINIC INC
- Practice address
- 3501 Douglas Dr N
Crystal, MN 55422-2415 - Phone
- (763) 535-9601
- Fax
- (763) 535-5601
- NPI assigned
- Jan 17, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Roxanne M Urbashich
- Title
- Office Manager
- Phone
- (763) 535-9601
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
3501 Douglas Dr N
Crystal, MN 55422-2415
Mailing address
3501 Douglas Dr N
Crystal, MN 55422-2415
Phone (763) 535-9601
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0005733572 | Other | AETNA | |
| 442672100 | Medicaid | MN | |
| 085N8NE | Other | BLUES | |
| P044 | Other | UCARE |
Other names 1
- NEW HOPE CRYSTAL MEDICAL CLINIC
National Provider Directory
National Provider DirectoryLocations
3501 Douglas Dr N
Minneapolis, MN 55422
Phone (763) 535-9601
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200528000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1357603200000",
"number": "1366628554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3501 DOUGLAS DR N",
"city": "CRYSTAL",
"state": "MN",
"postal_code": "554222415",
"telephone_number": "763-535-9601",
"fax_number": "763-535-5601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3501 DOUGLAS DR N",
"city": "CRYSTAL",
"state": "MN",
"postal_code": "554222415",
"telephone_number": "763-535-9601",
"fax_number": "763-535-5601"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CRYSTAL NEW HOPE MEDICAL CLINIC INC",
"organizational_subpart": "NO",
"enumeration_date": "2008-01-17",
"last_updated": "2013-01-08",
"status": "A",
"authorized_official_last_name": "URBASHICH",
"authorized_official_first_name": "ROXANNE",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "763-535-9601"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0005733572",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "442672100",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUES",
"identifier": "085N8NE",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "P044",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "NEW HOPE CRYSTAL MEDICAL CLINIC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Crystal, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.