Tubman

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

8004872MHC Issued in MN

Legal business name

TUBMAN

Practice address

4432 Chicago Avenue South
Minneapolis, MN 55407

Phone

(612) 870-2444

Fax

(612) 870-2428

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Beverly Dusso

Title

Executive Director

Phone

(612) 767-6690

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Tubman Family Alliance & Chrysalis A Center for Women Inc Former legal business name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Tax ID family

Chrysalis2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Tubman

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Minneapolis, MN
  • NPI 1295866911
  NPD tax ID

Locations

Practitioners 4

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

• Beverly Jean Caruso, LICENSED INDEPENDENT

  • Psychologist
  • St Louis Park, MN
  • NPI 1336256916
  Medicare reassignment Care Compare group NPD
• Birgit Olsen Kelly, LICSW

  • Clinical Social Worker
  • Coon Rapids, MN
  • NPI 1346420643
  Medicare reassignment Care Compare group NPD
• April Leta Wolfson, RN, CNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Shakopee, MN
  • NPI 1093862732
  Medicare reassignment Care Compare group NPD
• Susan Rose Roeller, MSW, LICSW

  • Clinical Social Worker
  • Coon Rapids, MN
  • NPI 1801193123
  Medicare reassignment NPD

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225756800000",
    "number": "1376655159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4432 CHICAGO AVENUE SOUTH",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55407",
            "telephone_number": "612-870-2444",
            "fax_number": "612-870-2428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4432 CHICAGO AVENUE SOUTH",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55407",
            "telephone_number": "612-870-2444",
            "fax_number": "612-870-2428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUBMAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2008-11-04",
        "status": "A",
        "authorized_official_last_name": "DUSSO",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "612-767-6690"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MN",
            "license": "8004872MHC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "257080700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tubman Family Alliance & Chrysalis A Center for Women Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Dean T Tsukayama, MD
• Andy A Tu, DDS
• Margaret Tu, D.C.
• Shanna Tubbs, DPT
• Tubman
• Tubman
• David E Tubman, M.D.
• Kathryn Marie Tubman, MS, CCC-SLP
• Cecilia L Tubolino, NNP
• Smyrna Tuburan, MD

• Mental Health Clinic/Center (Including Community Mental Health Center) in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2008; 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.