NPIMap

Organization Active NPI

Southern Cities Clinic

  • General Practice Physician
  • Faribault, MN
National Provider Identifier
1437218740
Registry record updated Jan 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
SOUTHERN CITIES CLINIC
Practice address
400 4TH St NW
Faribault, MN 55021-5031
Phone
(507) 384-6830
NPI assigned
Dec 6, 2006
Last updated
Jan 28, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2026

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

Authorized official

Name
Melissa Ells, PHARMDNPI 1164728028
Title
Ambulatory Care Executive Director
Phone
(651) 539-7200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

400 4TH St NW
Faribault, MN 55021-5031

Mailing address

3200 Labore Rd Ste 104
Vadnais Heights, MN 55110-5186

Other identifiers 1

IdentifierTypeStateIssuer
496053000MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050318000140 MN Part B Supplier - Clinic/Group Practice 7517912991 Receives reassigned benefits from 12 practitioners
Practice locations: Faribault, MN

National Provider Directory

National Provider Directory
Tax ID family
Southern Cities Community3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

200 W 98th St
Bloomington, MN 55420
Phone (952) 881-4421

200 Western Ave NW
Ste A3A
Faribault, MN 55021
Phone (507) 333-2028

330 Heritage Pl
Faribault, MN 55021
Phone (507) 332-8461

8100 Penn Ave S
Ste 154
Minneapolis, MN 55431
Phone (612) 968-6097

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769558400000",
    "number": "1437218740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 LABORE RD STE 104",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551105186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 4TH ST NW",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550215031",
            "telephone_number": "507-384-6830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CITIES CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2026-01-28",
        "certification_date": "2026-01-28",
        "status": "A",
        "authorized_official_last_name": "ELLS",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "AMBULATORY CARE EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "651-539-7200",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "496053000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Faribault, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2026; 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.