Minnesota Vascular Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

PENDING Issued in MN

Legal business name

MINNESOTA VASCULAR SURGERY CENTER

Practice address

600 County Road D
New Brighton, MN 55112-3519

Phone

(763) 432-4300

Fax

(763) 432-4301

NPI assigned

Feb 9, 2007

Last updated

Dec 17, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lisa G. Norby

Title

Executive Assistant/Credentialing

Phone

(763) 398-2203

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Listed as

Minnesota Vascular Surgery CenterCCN 24C0001057

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• West Imaging, LLC

  dba Minneapolis Radiology-Robbinsdale

  • Diagnostic Radiology Physician
  • Plymouth, MN
  • NPI 1053311399

  Member Of

  NPD member

Locations

Practitioners 4

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.

• Charles Marquardt, MD

  • Vascular Surgery Physician
  • Coon Rapids, MN
  • NPI 1477180115
  Medicare reassignment NPD
• Eric David Irwin, MD

  • Surgery Physician
  • Minneapolis, MN
  • NPI 1184731226
  NPD (past)
• Christopher Michael McAninch, M.D.

  • Vascular Surgery Physician
  • Plymouth, MN
  • NPI 1215370085
  NPD (past)
• Scott Robert Schultz, MD

  • Diagnostic Radiology Physician
  • Robbinsdale, MN
  • NPI 1821098872
  NPD (past)

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355702400000",
    "number": "1568503845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 COUNTY ROAD D",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551123519",
            "telephone_number": "763-432-4300",
            "fax_number": "763-432-4301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 COUNTY ROAD D",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551123519",
            "telephone_number": "763-432-4300",
            "fax_number": "763-432-4301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA VASCULAR SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2012-12-17",
        "status": "A",
        "authorized_official_last_name": "NORBY",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT/CREDENTIALING",
        "authorized_official_telephone_number": "763-398-2203"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MN",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "508958000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mia Mikel, L.A.D.C.
• William Miller, D.C.
• Mina Medical Clinic LLC
• Mindful Recovery Services LLC
• Minn Care Home Health
• Leonard Moeller, LAMFT
• Hodan Abdinasir Mohamed
• Maria Mohamed
• Samia Abdirahman Mohamed, MA
• Aesha Abdifatah Mohamud

• Ambulatory Surgical Clinic/Center in New Brighton, MN
• Providers in New Brighton, MN by specialty
• Ambulatory Surgical Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.