NPIMap

Organization Active NPI

Integrated Care Clinics, PA

Doing business as Great River Spine & Sport

  • Physical Therapist
  • Monticello, MN
National Provider Identifier
1396775110
Registry record updated Oct 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
8397 Issued in MN
Legal business name
INTEGRATED CARE CLINICS, PA
Doing business as
Great River Spine & Sport
Practice address
1260 Highway 25 S
Monticello, MN 55362-8921
Phone
(763) 260-8401
Fax
(763) 295-2208
NPI assigned
Jul 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2019

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

Authorized official

Name
Bill E Mickle, DCNPI 1790907434
Title
Owner
Phone
(763) 260-8401

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 6

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X 44760 MN
Spinal Cord Injury Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P0004X 44760 MN
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X 44760
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X 44760 MN
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 8397 MN Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X R182757-0 MN

Addresses

Primary practice location

1260 Highway 25 S
Monticello, MN 55362-8921

Mailing address

1260 Highway 25 S
Monticello, MN 55362-8921
Phone (763) 263-8401

Other practice location 1

751 Rose Dr Ste 108
Big Lake, MN 55309-8870
Phone (763) 260-8401 ext. 2

Other names 1

  • Great River Spine & Sport Doing business as

National Provider Directory

National Provider Directory

Locations

13968 1St St
Becker, MN 55308
Phone (763) 262-0555

751 Rose Dr
Ste 108
Big Lake, MN 55309
Phone 7632608401 ext. 2

Practitioners & affiliated clinicians

Practitioners 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571356800000",
    "number": "1396775110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 HIGHWAY 25 S",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553628921",
            "telephone_number": "763-263-8401",
            "fax_number": "763-263-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 HIGHWAY 25 S",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553628921",
            "telephone_number": "763-260-8401",
            "fax_number": "763-295-2208"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "751 Rose Dr Ste 108",
            "address_purpose": "LOCATION",
            "city": "Big Lake",
            "state": "MN",
            "postal_code": "553098870",
            "country_code": "US",
            "telephone_number": "763-260-8401 x2",
            "fax_number": "763-273-8921",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTEGRATED CARE CLINICS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2019-10-18",
        "status": "A",
        "authorized_official_last_name": "MICKLE",
        "authorized_official_first_name": "BILL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-260-8401",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "MN",
            "license": "44760",
            "primary": false
        },
        {
            "code": "2081P0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine",
            "state": "MN",
            "license": "44760",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": "44760",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "MN",
            "license": "44760",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "8397",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R182757-0",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great River Spine & Sport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monticello, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; 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.