Allina Health System
Organization Active NPI Obesity Medicine (Family Medicine) Physician · Coon Rapids, MN
NPI 1457657256 · NPPES record last updated Mar 21, 2024
Key facts
- NPI
- 1457657256
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Obesity Medicine (Family Medicine) Physician 207QB0002X
- Legal business name
- ALLINA HEALTH SYSTEM
- Practice address
- 11850 Blackfoot St NW Ste 130
Coon Rapids, MN 55433-2583 - Phone
- (763) 236-2045
- Fax
- (763) 236-2044
- NPI assigned
- Jan 27, 2011
- Organization subpart
- No
Authorized official
- Name
- Dominico Tallarico
- Title
- Coo
- Phone
- (612) 222-2222
Practitioners 35
-
Erin Aline Ashby, CRNA
-
Kristi Jo Backer Palmer, O.D.
-
Leslie A Baken, MD
-
Aaron Binstock, M.D.
-
Jenny M Bliss, PMHNP
-
Julie Christine Daly, LMFT
-
Jonathan Ross Dickman, M.D., PHD
-
Molly B Gruber, DO
-
Gary Hagen, CRNA
-
Jessica Lin Hansen, D.O.
-
Douglass S. Hassell, M.D.
-
Micah Olaf Johnson, M.D.
-
Julie Ann Kammer, MD
-
Chandrawatie Khemraj, APRN
-
Loretta Renee Krahn, CRNA
-
Thomas Nicholas Kurvers, M.D.
-
Lisa Jo Lippold, MA, LPCC, LADC
-
Jill Marrone, MS, RD, LD
-
Prasanthi Meagher, M.D
-
Sapna N Patel, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
| O20221213001713 | MN | Part B Supplier - Clinic/Group Practice | 4587573613 |
Receives reassigned benefits from 3,000 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
Locations
2925 Chicago Ave
#10202
Minneapolis, MN 55407
Phone (612) 262-4589
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian |
133V00000X | |||
| Obesity Medicine (Family Medicine) Physician |
207QB0002X | Yes | ||
| Obesity Medicine (Preventive Medicine) Physician |
2083B0002X | |||
| Clinic/Center | 261Q00000X |
Addresses
Primary practice location
11850 Blackfoot St NW Ste 130
Coon Rapids, MN 55433-2583
Mailing address
PO Box 43
Mail Route 10860
Minneapolis, MN 55440-0043
Phone (612) 262-1166
Other names
- Allina Health Weight Management-Mercy
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service | Other | Ciox Health |
Other providers in Coon Rapids, MN
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
All providers in Coon Rapids, MN · Obesity Medicine (Family Medicine) Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.