NPIMap

Organization Active NPI

Chaska Medical Center

Doing business as Crossroads Medical Centers PA

  • Family Medicine Physician
  • Prior Lake, MN
National Provider Identifier
1447304886
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
153 Issued in MN
Legal business name
CHASKA MEDICAL CENTER
Doing business as
Crossroads Medical Centers PA
Practice address
14033 Commerce Ave NE
Prior Lake, MN 55372-1438
Phone
(952) 447-1700
Fax
(952) 447-1708
NPI assigned
Jan 23, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
John A Rekow
Title
Administrator
Phone
(952) 361-0529

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 153 MN Primary

Addresses

Primary practice location

14033 Commerce Ave NE
Prior Lake, MN 55372-1438

Mailing address

14033 Commerce Ave NE
Prior Lake, MN 55372
Phone (952) 447-1700

Other identifiers 1

IdentifierTypeStateIssuer
51172CHOtherMNBCBS

Other names 1

  • Crossroads Medical Centers PA Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Chaska Medical Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447304886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14033 COMMERCE AVE NE",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "55372",
            "telephone_number": "952-447-1700",
            "fax_number": "952-447-1708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14033 COMMERCE AVE NE",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553721438",
            "telephone_number": "952-447-1700",
            "fax_number": "952-447-1708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHASKA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REKOW",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "952-361-0529"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "153",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "51172CH",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Medical Centers PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prior Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.