NPIMap

Organization Active NPI

Northstar Regional

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Chaska, MN
National Provider Identifier
1659764587
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
NORTHSTAR REGIONAL
Practice address
1045 Stoughton Ave
Chaska, MN 55318-2149
Phone
(952) 974-3999
NPI assigned
Mar 17, 2015
Last updated
Apr 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

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

Authorized official

Name
Elisa L Johnson
Title
Contracting/Credentialing/Billing
Phone
(952) 856-3932

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU Primary
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

1045 Stoughton Ave
Chaska, MN 55318-2149

Mailing address

1045 Stoughton Ave
Chaska, MN 55318-2149
Phone (952) 448-6557

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190228000530 MN Part B Supplier - Clinic/Group Practice 8921346669 Receives reassigned benefits from 13 practitioners
Practice locations: Chaska, MN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

500 Marschall Rd
Ste 100
Shakopee, MN 55379
Phone (952) 448-6557

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1426550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745280000000",
    "number": "1659764587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 STOUGHTON AVE",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "553182149",
            "telephone_number": "952-448-6557",
            "fax_number": "952-448-6047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 STOUGHTON AVE",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "553182149",
            "telephone_number": "952-974-3999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSTAR REGIONAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-17",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ELISA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CONTRACTING/CREDENTIALING/BILLING",
        "authorized_official_telephone_number": "952-856-3932"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chaska, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; 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.