NPIMap

Organization Active NPI

The Bridge Autism Clinic LLC

  • Adolescent and Children Mental Health Clinic/Center
  • St Paul, MN
National Provider Identifier
1568017374
Registry record updated Dec 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
THE BRIDGE AUTISM CLINIC LLC
Practice address
690 Cleveland Ave South
Suite 100
St Paul, MN 55116
Phone
(612) 216-4647
NPI assigned
Aug 8, 2019
Organization subpart
Yes
Parent organization
THE BRIDGE AUTISM CLINIC LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 10, 2019

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

Authorized official

Name
Melissa Hamilton
Title
Director Ceo
Phone
(651) 493-8412

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

690 Cleveland Ave South
Suite 100
St Paul, MN 55116

Mailing address

690 Cleveland Ave S # 100
Saint Paul, MN 55116-1319

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260529000277 MN Part B Supplier - Clinic/Group Practice 8729558937 Receives reassigned benefits from 2 practitioners
Practice locations: Mendota Heights, MN; Saint Paul, MN

National Provider Directory

National Provider Directory
Part of
The Bridge Autism Clinic LLC

Locations

690 Cleveland Ave S
#100
Saint Paul, MN 55116

690 Cleveland Ave S
Ste 100
Saint Paul, MN 55116
Phone (651) 493-8412

1043 Grand Ave
#231
Saint Paul, MN 55105

Practitioners & affiliated clinicians

Practitioners 228

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 228

NPI Registry JSON

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

{
    "created_epoch": "1565222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575936000000",
    "number": "1568017374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 CLEVELAND AVE S # 100",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551161319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 CLEVELAND AVE SOUTH",
            "address_2": "SUITE 100",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "55116",
            "telephone_number": "612-216-4647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BRIDGE AUTISM CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE BRIDGE AUTISM CLINIC LLC",
        "enumeration_date": "2019-08-08",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "DIRECTOR CEO",
        "authorized_official_telephone_number": "651-493-8412"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2019; 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.