NPIMap

Organization Active NPI

Neighborhood Healthsource

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
National Provider Identifier
1386682078
Registry record updated Jun 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NEIGHBORHOOD HEALTHSOURCE
Practice address
3300 Fremont Ave N
Minneapolis, MN 55412-2405
Phone
(612) 588-9411
Fax
(612) 522-6627
NPI assigned
Jun 3, 2006
Last updated
Jun 29, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2023

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

Authorized official

Name
Mr. Steve J Knutson
Title
Executive Director
Phone
(612) 287-2428

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3300 Fremont Ave N
Minneapolis, MN 55412-2405

Mailing address

3300 Fremont Ave N
Minneapolis, MN 55412-2405
Phone (612) 588-9411

Other names 1

  • Fremont Community Health Services, Inc Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040729000231 MN Part B Supplier - Clinic/Group Practice 9133199953 Receives reassigned benefits from 16 practitioners
4 other NPIs on this enrollment
Practice locations: Coon Rapids, MN; Minneapolis, MN
O20090917000659 MN Part A Provider - Federally Qualified Health Center (FQHC) 9133199953 Practice locations: Minneapolis, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386682078. Details of each certification follow.

Federally qualified health center certification: CCN 241813

Legal name
NEIGHBORHOOD HEALTHSOURCE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1994
Last certification
Jan 1, 1994
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jun 18, 1975 in MN
Enrollment address
3300 Fremont N Ave
Minneapolis, MN 55412-2405

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D1026553Fremont Community Health Services Inc3300 Fremont Avenue N, Minneapolis, MN 55412Certificate of waiverJun 7, 2028

National Provider Directory

National Provider Directory

Locations

3300 Fremont Ave N
Minneapolis, MN 55412
Phone (612) 588-9411

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Curt J Engels Individual Corporate DirectorFinance Director Jul 24, 2023
W-2 Managing EmployeeFinance Director Jul 24, 2023
Philip Denny Individual Corporate DirectorBoard Member Jun 1, 2024
Mayte Cambara Individual Corporate DirectorBoard Member Jun 1, 2024
Steven J Knutson Individual Corporate Officer Mar 18, 2009
W-2 Managing EmployeeExecutive Director Mar 17, 2009
Gloria J Peterson Individual Corporate DirectorBoard Member Jun 1, 2024
Carroll Barnes Individual Corporate DirectorBoard Member Jun 1, 2024
Nathan Ebnet Individual Corporate DirectorBoard Member Jun 1, 2024
Doug Christensen Individual Corporate DirectorBoard Member Jun 1, 2024
Victor Wong Individual Corporate DirectorBoard Member Jun 1, 2024
Roberta Ridyn Kelley Individual Corporate DirectorBoard Member Feb 10, 2020

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687996800000",
    "number": "1386682078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 FREMONT AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554122405",
            "telephone_number": "612-588-9411",
            "fax_number": "612-522-6627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 FREMONT AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554122405",
            "telephone_number": "612-588-9411",
            "fax_number": "612-522-6627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEIGHBORHOOD HEALTHSOURCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A",
        "authorized_official_last_name": "KNUTSON",
        "authorized_official_first_name": "STEVE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "612-287-2428",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fremont Community Health Services, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Fremont Community Health Services, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.