NPIMap

Organization Active NPI

Allina Health System

Doing business as Abbott Northwestern Wound Clinic

  • Internal Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1407893936
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ALLINA HEALTH SYSTEM
Doing business as
Abbott Northwestern Wound Clinic
Practice address
800 E 28TH St
Minneapolis, MN 55407-3723
Phone
(612) 863-3110
NPI assigned
Jun 1, 2006
Last updated
Jan 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Authorized official

Name
Dominica Tallarico
Title
Coo
Phone
(612) 222-2222

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

800 E 28TH St
Minneapolis, MN 55407-3723

Mailing address

PO Box 43
Mail Route 10585
Minneapolis, MN 55440-0043
Phone (612) 262-1166

Other names 1

  • Abbott Northwestern Wound Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service Other Ciox Health

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, FL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20030505000007 MN Part A Provider - Hospital 4587573613 29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
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
O20171130000956 FL Part B Supplier - Clinic/Group Practice 4587573613 Receives reassigned benefits from 1 practitioner
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Inlet Beach, FL; West Palm Beach, FL; Temple Terrace, FL; Orlando, FL; Miramar, FL; Minneola, FL; Melbourne, FL; Largo, FL…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407893936. Details of each certification follow.

Hospital certification: CCN 240057

Legal name
ALLINA HEALTH SYSTEM
Doing business as
ABBOTT NORTHWESTERN HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jan 8, 1970
Last certification
Jan 4, 2018
Beds
996 (952 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
800 E 28TH St
Minneapolis, MN 55407-3723
Hospital subgroups
General, Acute care, Other

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 28

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 28

Care Compare: Hospital

Medicare Care Compare
Listed as
Abbott Northwestern HospitalCCN 240057 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 26

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Challis Lowe Individual Corporate DirectorBoard Member Jun 8, 2022
John Richard Church Individual Corporate DirectorBoard Member Sep 9, 2021
Laura Jean Gillund Individual Corporate DirectorBoard Member Jun 10, 2015
Amy L Ronneberg Individual Corporate DirectorBoard Member Dec 1, 2020
Daniel Thomas O'Laughlin Individual Corporate DirectorBoard Member Jan 1, 2022
Maykao Y Hang Individual Corporate DirectorBoard Member Jun 13, 2019
David Allan Joos Individual Corporate OfficerPresident Apr 20, 2022
Brian McGrane Individual Corporate DirectorBoard Member Jun 14, 2024
Marna Borgstrom Individual Corporate DirectorBoard Member Jun 13, 2025
Jennifer Soo Alstad Individual Corporate DirectorBoard Member Jun 10, 2016
Shari L Ballard Individual Corporate DirectorBoard Member Jun 10, 2020
Timothy Aloysius Welsh Individual Corporate DirectorBoard Member Dec 1, 2017
Vicki Rasmusen Individual Corporate DirectorBoard Member Jun 13, 2019
Debbra Schoneman Individual Corporate DirectorBoard Member Jun 13, 2013
James Kolar Individual Corporate DirectorBoard Member Sep 13, 2024
Lisa Shannon Individual Corporate DirectorPresident and Ceo Jan 1, 2022
Shawn M Ulreich Individual Corporate DirectorBoard Member Sep 13, 2023
Chanda L Baker Individual Corporate DirectorBoard Member Feb 20, 2024
Melinda Estes Individual Corporate DirectorBoard Member Jun 13, 2025
Louis Julius King Individual Corporate DirectorBoard Member Jun 12, 2017
Ruth Evelyn Williams-Brinkley Individual Corporate DirectorBoard Member Sep 13, 2023
Patricia W Schirmers Individual W-2 Managing EmployeeDirector Reimbursement May 5, 2003
Barbara a Butts Williams Individual Corporate DirectorBoard Member Jun 10, 2015
Thomas S Schreier Individual Corporate DirectorBoard Member Mar 12, 2014
Dominica Marie Tallarico Individual Corporate OfficerCoo Mar 11, 2024
Roger Scott Newcome Individual W-2 Managing EmployeeManager Reimbursement May 6, 2016

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 30

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 30

Affiliated clinicians 2,935

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 2,935

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1407893936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43",
            "address_2": "MAIL ROUTE 10585",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554400043",
            "telephone_number": "612-262-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E 28TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073723",
            "telephone_number": "612-863-3110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLINA HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A",
        "authorized_official_last_name": "TALLARICO",
        "authorized_official_first_name": "DOMINICA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "612-222-2222"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.6635.1.1",
            "affiliationName": "Ciox Health",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "925 N Point Pkwy",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300055210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Abbott Northwestern Wound Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.