Gannon Raguse

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

9120 Springbrook Dr NW
Coon Rapids, MN 55433

Phone

(763) 231-2590

NPI assigned

May 22, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fraser Child and Family Center

  • Adolescent and Children Mental Health Clinic/Center
  • Minneapolis, MN
  • NPI 1609922194
  NPD
• Fraser

  • Rehabilitation Clinic/Center
  • Richfield, MN
  • NPI 1063568574
  NPD (past)

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

{
    "created_epoch": "1558483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563148800000",
    "number": "1386201580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20311 DOVE LN",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564017027",
            "telephone_number": "218-232-3057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9120 SPRINGBROOK DR NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "55433",
            "telephone_number": "763-231-2590"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3333 University Ave SE",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554143325",
            "country_code": "US",
            "telephone_number": "218-232-3057",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAGUSE",
        "first_name": "GANNON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-05-22",
        "last_updated": "2019-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Qualicare Homes Corporation
• Marianna Kristine Anderson Quanbeck
• William F Qubty, MD
• Timothy J Rabb, NP
• Nicole Terese Radke, CNP
• Shakunthala Raja-Heal, MD
• Diana Kay Ramone
• Paige Ramsey, MS, BCBA
• Daniel Craig Randa, M.D.
• Megan L M Randall, PA-C

• Behavior Technician in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Behavior Technician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.