NPIMap

Allina Health System

Organization Active NPI Family Medicine Physician · Minneapolis, MN

NPI 1649757261 · NPPES record last updated Feb 25, 2025

Key facts

NPI
1649757261
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
ALLINA HEALTH SYSTEM
Practice address
3270 W Lake St
Minneapolis, MN 55416-4512
Phone
(612) 775-1800
Fax
(612) 775-1805
NPI assigned
Jul 26, 2018
Organization subpart
No

Authorized official

Name
Dominica Tallarico
Title
Coo
Phone
(612) 222-2222

Practitioners 31

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

View all 31

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2166287Allina Health Clinic - Greenway & Allina Health
3270 W Lake Street, Minneapolis, MN 55416		AccreditationAug 25, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MN

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

3270 W Lake St
Minneapolis, MN 55416-4512

Mailing address

PO Box 43
Mail Route 10585
Minneapolis, MN 55440-0043
Phone (612) 262-1166

Other names

  • Allina Health Greenway Clinic Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service Other Ciox Health

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 25, 2025.

{
    "created_epoch": "1532563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740441600000",
    "number": "1649757261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43",
            "address_2": "MAIL ROUTE 10585",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554400043",
            "telephone_number": "612-262-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3270 W LAKE ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554164512",
            "telephone_number": "612-775-1800",
            "fax_number": "612-775-1805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLINA HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-26",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A",
        "authorized_official_last_name": "TALLARICO",
        "authorized_official_first_name": "DOMINICA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "612-222-2222"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.6635.1.1",
            "affiliationName": "Ciox Health",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "925 N Point Pkwy",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300055210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Allina Health Greenway Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Allina Health Greenway Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

All providers in Minneapolis, MN · Family Medicine Physician in Minnesota

Sources for this page

Verify at the official NPI Registry.