NPIMap

Organization Active NPI

Fairview Express Care

Doing business as Institute for Athletic Medicine

  • Physical Therapy Clinic/Center
  • Minneapolis, MN
National Provider Identifier
1407834302
Registry record updated Jan 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
FAIRVIEW EXPRESS CARE
Doing business as
Institute for Athletic Medicine
Practice address
2600 39TH Ave NE
Ste 220
Minneapolis, MN 55421-4379
Phone
(612) 789-0417
Fax
(612) 789-0522
NPI assigned
Jan 3, 2006
Last updated
Jan 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2023

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

Authorized official

Name
Robert Andrew McCoy
Title
VP Revenue Management
Phone
(612) 672-6594

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X MN Primary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X

Addresses

Primary practice location

2600 39TH Ave NE
Ste 220
Minneapolis, MN 55421-4379

Mailing address

PO Box 9372
Minneapolis, MN 55440-9372
Phone (612) 672-6724

Other identifiers 27

IdentifierTypeStateIssuer
240725601MedicaidMN
240725604MedicaidMN
240725608MedicaidMN
240725609MedicaidMN
240725613MedicaidMN
240725615MedicaidMN
240725621MedicaidMN
240725600MedicaidMN
240725603MedicaidMN
240725625MedicaidMN
116422800MedicaidMN
240725606MedicaidMN
240725616MedicaidMN
207168200MedicaidMN
240725610MedicaidMN
240725623MedicaidMN
240725602MedicaidMN
240725611MedicaidMN
240725619MedicaidMN
240725605MedicaidMN
240725607MedicaidMN
240725612MedicaidMN
240725617MedicaidMN
240725618MedicaidMN
240725626MedicaidMN
240725614MedicaidMN
240725627MedicaidMN

Other names 1

  • Institute for Athletic Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081028000548 MN Part B Supplier - Clinic/Group Practice 3375645179 Receives reassigned benefits from 4,146 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Fairview Express Care20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Locations

6545 France Ave S
Ste 450
Edina, MN 55435
Phone (612) 626-6688

2600 39th Ave NE
Ste 220
Saint Anthony, MN 55421
Phone (612) 672-7100

Practitioners & affiliated clinicians

Practitioners 91

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 91

NPI Registry JSON

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673827200000",
    "number": "1407834302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9372",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554409372",
            "telephone_number": "612-672-6724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 39TH AVE NE",
            "address_2": "STE 220",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554214379",
            "telephone_number": "612-789-0417",
            "fax_number": "612-789-0522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRVIEW EXPRESS CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-03",
        "last_updated": "2023-01-16",
        "certification_date": "2023-01-16",
        "status": "A",
        "authorized_official_last_name": "MCCOY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "VP REVENUE MANAGEMENT",
        "authorized_official_telephone_number": "612-672-6594"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MN",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
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        },
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            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "240725604",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "240725608",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "240725609",
            "state": "MN"
        },
        {
            "code": "05",
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            "issuer": null,
            "identifier": "240725613",
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        },
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            "identifier": "240725600",
            "state": "MN"
        },
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            "code": "05",
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            "identifier": "240725603",
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            "code": "05",
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            "code": "05",
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            "identifier": "116422800",
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            "code": "05",
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            "identifier": "240725606",
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        {
            "code": "05",
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            "identifier": "240725616",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207168200",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "240725610",
            "state": "MN"
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        {
            "code": "05",
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            "identifier": "240725623",
            "state": "MN"
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            "code": "05",
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            "code": "05",
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            "code": "05",
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            "state": "MN"
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            "code": "05",
            "desc": "MEDICAID",
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            "state": "MN"
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            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "240725627",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Institute for Athletic Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Institute for Athletic Medicine",
            "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 Jan 16, 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.