Columbia Park Medical Group, PA

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

COLUMBIA PARK MEDICAL GROUP, PA

Practice address

10961 Club West Pkwy
Blaine, MN 55449-4671

Phone

(763) 572-5710

Fax

(763) 528-2945

NPI assigned

Sep 13, 2006

Last updated

Nov 13, 2007By the provider in NPPES

Organization subpart

Yes

Parent organization

COLUMBIA PARK MEDICAL GROUP, PAAs reported in NPPES

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

Authorized official

Name

Joen V Condon

Title

Chief Financial Officer

Phone

(763) 586-5839

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• CPMG-Blaine Clinic Other name

Part of

Columbia Park Medical Group

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.

• James Patrick Bergstrom, M.D.

  • Internal Medicine Physician
  • Fridley, MN
  • NPI 1588626386
  NPD (past)

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1386749851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6401 UNIVERSITY AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554324341",
            "telephone_number": "763-572-5710",
            "fax_number": "763-571-3008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10961 CLUB WEST PKWY",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554494671",
            "telephone_number": "763-572-5710",
            "fax_number": "763-528-2945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUMBIA PARK MEDICAL GROUP, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLUMBIA PARK MEDICAL GROUP, PA",
        "enumeration_date": "2006-09-13",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "CONDON",
        "authorized_official_first_name": "JOEN",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "763-586-5839"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "02071BR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE CLINIC NUMBER",
            "identifier": "181992",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE URGENT CARE",
            "identifier": "UC0035",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "AQ909",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CT1003",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CPMG-Blaine Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Club West Chiropractic PA
• Ronnie Andy Co
• Antionette Ruby Coates
• Megan Collins, APRN, FNP-C
• Stephen John Collins, DC.
• Columbia Park Medical Group, PA
• Brianna Columbus
• Karen Dizon Competente, D.D.S.
• Complete Eyecare P L C (Lens Crafters)
• Coon Rapids Chiropractic Health Services LTD

• Multi-Specialty Clinic/Center in Blaine, MN
• Providers in Blaine, MN by specialty
• Multi-Specialty Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; 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.