NPIMap

Individual provider Active NPI

Amanda Elizabeth Leino, MD

  • Family Medicine Physician
  • Glencoe, MN
National Provider Identifier
1598754335
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
44767 Issued in MN
Practice address
1805 Hennepin Ave N
Glencoe, MN 55336-1416
Phone
(320) 864-3121
Fax
(320) 864-7887
NPI assigned
Oct 14, 2005
Last updated
Nov 24, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 44767 MN Primary

Addresses

Primary practice location

1805 Hennepin Ave N
Glencoe, MN 55336-1416

Mailing address

1805 Hennepin Ave N
Glencoe, MN 55336-1416
Phone (320) 864-3121

Other identifiers 1

IdentifierTypeStateIssuer
741127800MedicaidMN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address aleino94236@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040805000587 MN Practitioner - Family Practice 9830160480 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Glencoe Regional Health ServicesGroup PAC ID 1759292980, 45 clinicians
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

1805 Hennepin Ave N
Glencoe, MN 55336-1416
Phone (320) 864-3121

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
44767MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Family Medicine CurrentSince Feb 1, 2018 Accepting new patients
Park Nicollet Methodist Hospital CurrentSince Feb 1, 2018 Accepting new patients
Glencoe Regional Health Services CurrentSince Oct 1, 2004 Accepting new patients
Glencoe Regional Health Services CurrentSince Oct 1, 2004 Accepting new patients
Park Nicollet Clinic Family Medicine Current Accepting new patients

Locations

1805 Hennepin Ave N
Glencoe, MN 55336
Phone (320) 864-3121

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

6600 Excelsior Blvd
Ste 160
St Louis Park, MN 55426
Phone (952) 993-7700

Interoperability endpoints

  • Direct secure messaging: aleino94236@excellian.direct.allina.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1598754335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 HENNEPIN AVE N",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553361416",
            "telephone_number": "320-864-3121",
            "fax_number": "320-864-7887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 HENNEPIN AVE N",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553361416",
            "telephone_number": "320-864-3121",
            "fax_number": "320-864-7887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEINO",
        "first_name": "AMANDA",
        "middle_name": "ELIZABETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-14",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "44767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "741127800",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aleino94236@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "1805 Hennepin Ave N",
            "city": "Glencoe",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553361416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Glencoe, MN

Sources for this page

Verify at the official NPI Registry.