NPIMap

Individual provider Active NPI

Christopher J Church, PA

  • Physician Assistant
  • Faribault, MN
National Provider Identifier
1417022690
Registry record updated Sep 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10213 Issued in MN
Practice address
200 State Ave
Faribault, MN 55021-6339
Phone
(507) 497-3533
NPI assigned
Nov 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10213 MN Primary

Addresses

Primary practice location

200 State Ave
Faribault, MN 55021-6339

Mailing address

2829 University Ave SE Ste 730
Minneapolis, MN 55414-3279

Other identifiers 2

IdentifierTypeStateIssuer
362495000MedicaidMN
P00395174OtherMNRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070312000348 MN Practitioner - Physician Assistant 9234232299 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

200 State Ave
Faribault, MN 55021-6339
Phone (507) 334-6451

2925 Chicago Ave
Minneapolis, MN 55407-1321

Hospital & facility affiliations

  • Allina Health Faribault Medical Center Hospital, Faribault, MN, CCN 240071
  • Owatonna Hospital Hospital, Owatonna, MN, CCN 240069
  • North Memorial Health Hospital Hospital, Robbinsdale, MN, CCN 240001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
10213MNMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Dec 31, 2022 Accepting new patients
Allina Health System CurrentSince Jan 1, 2015 Accepting new patients
Saint Elizabeths Hospital of Wabasha Inc CurrentSince Sep 26, 2016 Accepting new patients
Allina Health System CurrentSince Jan 1, 2015 Accepting new patients
Ecc Addiction & Toxicology Services LLC CurrentSince Sep 15, 2024 Accepting new patients
Allina Health System Past Accepting new patients
Allina Health System Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

200 State Ave
Faribault, MN 55021
Phone (507) 334-6451

1175 Nininger Rd
Hastings, MN 55033
Phone (651) 404-1000

2829 University Ave SE
Ste 730
Minneapolis, MN 55414
Phone (612) 439-1868

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547

7920 Old Cedar Ave S
Minneapolis, MN 55425
Phone (952) 428-1800

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

1200 Grant Blvd W
Wabasha, MN 55981
Phone (651) 565-4531

1629 E Division St
River Falls, WI 54022
Phone (715) 307-6000

Interoperability endpoints

  • Direct secure messaging: cchurch484182@direct.emplifyhealth.org

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1417022690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2829 UNIVERSITY AVE SE STE 730",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554143279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 STATE AVE",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550216339",
            "telephone_number": "507-497-3533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCH",
        "first_name": "CHRISTOPHER",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "362495000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00395174",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Faribault, MN

Sources for this page

Verify at the official NPI Registry.