NPIMap

Organization Active NPI

Team Health Care Clinic PC

Doing business as Team Care Clinic

  • Chiropractor
  • Champlin, MN
National Provider Identifier
1457458689
Registry record updated Nov 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2766 Issued in MN
Legal business name
TEAM HEALTH CARE CLINIC PC
Doing business as
Team Care Clinic
Practice address
12217 Champlin Dr
Champlin, MN 55316-1930
Phone
(763) 323-1492
Fax
(763) 422-1657
NPI assigned
Sep 20, 2006
Last updated
Nov 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2022

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

Authorized official

Name
Joseph Alan BertschNPI 1295731503
Title
Ceo
Phone
(763) 323-1492

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2766 MN Primary
Chiropractor 111N00000X 2767 MN
Chiropractor 111N00000X NU
Internist Chiropractor 111NI0900X 2076 MN
Specialist 174400000X 5938 MN
Specialist 174400000X 6548 MN
Sports Medicine (Family Medicine) Physician 207QS0010X 34627 MN

Addresses

Primary practice location

12217 Champlin Dr
Champlin, MN 55316-1930

Mailing address

12217 Champlin Dr
Champlin, MN 55316-1930
Phone (763) 323-1492

Other names 1

  • Team Care Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060202000131 MN Part B Supplier - Clinic/Group Practice 4183638885 Receives reassigned benefits from 8 practitioners
Practice locations: Champlin, MN
O20160509002371 MN Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 4183638885 Practice locations: Champlin, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457458689. Details of each certification follow.

  • CCN 246610 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 246610

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
TEAM HEALTH CARE CLINIC PC
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Feb 21, 2017
Last certification
Feb 21, 2017
Ownership / control type
Proprietary
Facility address
12217 Champlin Drive
Champlin, MN 55316

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0962516Team Health Care Clinic PC12217 Champlin Drive First Floor, Champlin, MN 55316Certificate of waiverJul 6, 2027

National Provider Directory

National Provider Directory

Locations

12217 Champlin Dr
Champlin, MN 55316
Phone (763) 323-1492

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668556800000",
    "number": "1457458689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12217 CHAMPLIN DR",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553161930",
            "telephone_number": "763-323-1492",
            "fax_number": "763-422-1657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12217 CHAMPLIN DR",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553161930",
            "telephone_number": "763-323-1492",
            "fax_number": "763-422-1657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEAM HEALTH CARE CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-16",
        "status": "A",
        "authorized_official_last_name": "BERTSCH",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "763-323-1492"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "2766",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "2767",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "111NI0900X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Internist",
            "state": "MN",
            "license": "2076",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MN",
            "license": "5938",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MN",
            "license": "6548",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MN",
            "license": "34627",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Team Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Team Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Champlin, MN

Sources for this page

Verify at the official NPI Registry.