Allina Health System
Organization Active NPI Clinic/Center · Elk River, MN
NPI 1386940732 · NPPES record last updated Jan 22, 2025
Key facts
- NPI
- 1386940732
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- ALLINA HEALTH SYSTEM
- Practice address
- 14181 Business Center Dr NW
Elk River, MN 55330-4654 - Phone
- (763) 236-0500
- Fax
- (763) 236-0565
- NPI assigned
- Feb 2, 2011
- Organization subpart
- No
Authorized official
- Name
- Dominica Tallarico
- Title
- Coo
- Phone
- (612) 222-2222
Practitioners 37
-
Erica Jo Baumann, PA-C
-
Neil E Brown, MD
-
Thomas C. Bryson, MD
-
Rachel Beth Burns, PA-C, MPAS
-
Kayla Marie Daulton, PA-C
-
Michael D Eckroth, PA-C
-
Sonja Harlane, APRN, CNP
-
Dang Q Huynh, CNP
-
Kenneth A Johns, MD
-
Jennifer Marie Kath, RD LD
-
Katherine Graham Katzung, M.D.
-
Yasha Kayan, MD
-
Valerie Lynn Marsella, PA-C
-
Ivan Rafael Matos Diaz, M.D.
-
Mary G Mattison-Wynn, PSY D LP
-
Brady Michelle Messmer, M.D.
-
Kelly Ann Moreno, DO
-
Renae Nealis, NP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D0994684 | Allina Health Elk River Clinic | Certificate of waiver | Sep 21, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in MN
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| St Francis Regional Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest (47.5%) | Nov 15, 2007 |
| Courage Kenny Rehabilitation Institute TRP |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Jun 1, 2013 Jun 1, 2013 |
| Allina Health Restorative Suites |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Nov 10, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040319000460 | MN | Part B Supplier - Clinic/Group Practice | 4587573613 |
Receives reassigned benefits from 4,246 practitioners This NPI is an additional NPI on the enrollment |
| O20120227000188 | MN | DME Supplier - Physician - Unknown Physician Specialty | 4587573613 | Practice locations: Elk River, MN |
| O20221213001713 | MN | Part B Supplier - Clinic/Group Practice | 4587573613 |
Receives reassigned benefits from 3,000 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
14181 Business Center Dr NW
Elk River, MN 55330-4654
Mailing address
PO Box 43
Mail Route 10585
Minneapolis, MN 55440-0043
Phone (612) 262-1166
Other names
- Allina Health Elk River Clinic
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service | Other | Ciox Health |
Other providers in Elk River, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.