NPIMap

Organization Active NPI

Primemed PLLC

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
National Provider Identifier
1396450953
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
PRIMEMED PLLC
Doing business as
Primemed PLLC
Practice address
322 W Lake St Ste 101
Minneapolis, MN 55408-3025
Phone
(857) 492-6395
Fax
(612) 465-4470
NPI assigned
Jan 18, 2023
Last updated
May 15, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2023

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

Authorized official

Name
Mr. Mohamed Adan, PA-CNPI 1336725837
Title
Physician Assistant
Phone
(857) 492-6395

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

322 W Lake St Ste 101
Minneapolis, MN 55408-3025

Mailing address

322 W Lake St Ste 101
Minneapolis, MN 55408-3025
Phone (857) 492-6395

Other names 1

  • Primemed PLLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230509000965 MN Part B Supplier - Clinic/Group Practice 6709241185 Receives reassigned benefits from 2 practitioners
Practice locations: Minneapolis, MN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1674000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684108800000",
    "number": "1396450953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 W LAKE ST STE 101",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554083025",
            "telephone_number": "857-492-6395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 W LAKE ST STE 101",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554083025",
            "telephone_number": "857-492-6395",
            "fax_number": "612-465-4470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMEMED PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-18",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A",
        "authorized_official_last_name": "ADAN",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "857-492-6395",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primemed PLLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Primemed PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; 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.