Allina Health System
Organization Active NPI Family Medicine Physician · Minneapolis, MN
NPI 1508162249 · NPPES record last updated Feb 24, 2025
Key facts
- NPI
- 1508162249
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ALLINA HEALTH SYSTEM
- Practice address
- 1221 W Lake St
Suite 201
Minneapolis, MN 55408 - Phone
- (612) 824-1772
- Fax
- (612) 821-4799
- NPI assigned
- Jan 27, 2011
- Organization subpart
- No
Authorized official
- Name
- Dominica Tallarico
- Title
- Coo
- Phone
- (612) 222-2222
Practitioners 38
-
Abdelwahaab Akef, M.D.
-
Azhar T. Ali, MBBS
-
Bryan Bader, APRN
-
Natasha Marie Benkovich, PA-C
-
Douglas M Berg, MD
-
Alicia Cain, LICSW
-
Daniel Keith Cantwell, D.O.
-
Sambath Cheath, FNP-C
-
John P Emmel, MD
-
Lynne A Gibeau, MD
-
Grady Hedstrom, MD
-
Kevin Henseler, M.D.
-
Krysta Hrdlichka, PA-C
-
Ashley Hundley, CNP
-
Jessica V Kealhofer, M.D.
-
Marc Kelliny, MD
-
Karen Klement, LICSW
-
Benjamin Dutton Meyer, M.D.
-
Heidi M Morrisey, C-FNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D0401651 | Allina Health Uptown Clinic | Certificate of waiver | Sep 22, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in MN
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| St Francis Regional Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest (47.5%) | Nov 15, 2007 |
| Courage Kenny Rehabilitation Institute TRP |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Jun 1, 2013 Jun 1, 2013 |
| Allina Health Restorative Suites |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Nov 10, 2022 |
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 |
| O20120229000735 | MN | DME Supplier - Physician - Unknown Physician Specialty | 4587573613 | Practice locations: Minneapolis, MN |
| 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
4040 Coon Rapids Blvd NW
Ste 120
Minneapolis, MN 55433
Phone (763) 427-9980
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Clinic/Center | 261Q00000X |
Addresses
Primary practice location
1221 W Lake St
Suite 201
Minneapolis, MN 55408
Mailing address
PO Box 43
Mail Route 10585
Minneapolis, MN 55440-0043
Phone (612) 262-1166
Other names
- Allina Health Uptown Clinic
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 Minneapolis, 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 Minneapolis, MN · 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 Feb 24, 2025. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.