Modern Ketamine Clinic

Primary specialty

Infusion Therapy Clinic/CenterTaxonomy code 261QI0500X

Legal business name

MODERN KETAMINE CLINIC

Practice address

13792 Reimer Dr N
Maple Grove, MN 55311-2219

Phone

(763) 347-2100

Fax

(763) 333-7174

NPI assigned

Sep 14, 2022

Last updated

May 28, 2025By 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

Daniel Gregory Falvey, MDNPI 1003194085

Title

MD

Phone

(763) 347-2100

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

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.

• Daniel Gregory Falvey, M.D.

  • Emergency Medicine Physician
  • Fargo, ND
  • NPI 1003194085

  MN

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1663113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748390400000",
    "number": "1386366532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13792 REIMER DR N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553112219",
            "telephone_number": "763-347-2100",
            "fax_number": "763-333-7174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13792 REIMER DR N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553112219",
            "telephone_number": "763-347-2100",
            "fax_number": "763-333-7174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN KETAMINE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-14",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A",
        "authorized_official_last_name": "FALVEY",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "GREGORY",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "763-347-2100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Priya Nmi Mitra
• MKMD Neurosurgery, PLLC (KIM Neurosurgery, PLLC)
• MN Spectrum Solutions (MNSS)
• MN UC Providers LTD (AFC Urgent Care)
• Gabrielle Diane Mocchi, D.C.
• Modern Point Acupuncture
• Kristin Lee Moen, MA, LPCC
• Maryam Lee Moghaddam, DO
• Ahmed A Mohamed
• Aisha Mohamed

• Infusion Therapy Clinic/Center in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Infusion Therapy Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 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.