Mngi Endoscopy ASC Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

PENDING Issued in MN

Legal business name

MNGI ENDOSCOPY ASC INC

Practice address

3001 Broadway St NE Ste 500
Minneapolis, MN 55413

Phone

(612) 871-1145

Fax

(612) 870-5491

NPI assigned

Jul 27, 2006

Last updated

Apr 2, 2024By 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

Scott Ketover, MD

Title

President

Phone

(612) 871-1145

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN6 enrollments

Enrollment records 6

Listed as

Mngi Endoscopy ASC IncCCN 24C0001044

Medicare certification status

ActiveFrom the Provider of Services file

Listed as

Mngi Endoscopy ASC Inc Dba Mngi Endoscopy LakevilleCCN 24C0001122

Medicare certification status

ActiveFrom the Provider of Services file

Listed as

Mngi Endoscopy ASC IncCCN 24C0001099

Medicare certification status

ActiveFrom the Provider of Services file

Listed as

Mngi Endoscopy ASC IncCCN 24C0001066

Medicare certification status

ActiveFrom the Provider of Services file

Listed as

Mngi Endoscopy ASC IncCCN 24C0001037

Medicare certification status

ActiveFrom the Provider of Services file

Listed as

Mngi Endoscopy ASC IncCCN 24C0001034

Medicare certification status

ActiveFrom the Provider of Services file

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

• Affiliated Endoscopy Centers, LLC

  • Ambulatory Surgical Clinic/Center
  • Vadnais Heights, MN
  • NPI 1518995513

  Member Of

  NPD member
• Valley Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Hudson, WI
  • NPI 1619614963

  Member Of

  NPD member

Locations

Practitioners 26

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.

• Zubin Arora, M.D.

  • Gastroenterology Physician
  • Woodbury, MN
  • NPI 1366706723
  NPD (past)
• Jennifer Elizabeth Burke, M.D., M.P.H.

  • Anesthesiology Physician
  • Minneapolis, MN
  • NPI 1447456744
  NPD (past)
• Gina Kleve Dardine, PA

  • Physician Assistant
  • Woodbury, MN
  • NPI 1477036317
  NPD (past)
• Michelle Marie Douvier, PA-C

  • Physician Assistant
  • Coon Rapids, MN
  • NPI 1831392554
  NPD (past)
• Katherine Ann Dow, CRNA

  • Certified Registered Nurse Anesthetist
  • Minneapolis, MN
  • NPI 1174827323
  NPD (past)
• Betsy S Ellingson, CRNA

  • Certified Registered Nurse Anesthetist
  • Minneapolis, MN
  • NPI 1457479495
  NPD (past)
• Bethany Lou Fiebelkorn Kennedy, PH.D.

  • Psychologist
  • Coon Rapids, MN
  • NPI 1598917692
  NPD (past)
• Kristin Frericks, APRN, CPNP

  • Pediatric Nurse Practitioner
  • Minneapolis, MN
  • NPI 1487385860
  NPD (past)
• Ying Gibbens, MD PHD

  • Gastroenterology Physician
  • Vadnais Heights, MN
  • NPI 1548721434
  NPD (past)
• Glenn Richard Gourley, M.D.

  • Pediatric Gastroenterology Physician
  • Minneapolis, MN
  • NPI 1689606287
  NPD (past)
• David Alan Griver, MD

  • Anesthesiology Physician
  • Saint Paul, MN
  • NPI 1720083405
  NPD (past)
• April B Grudell, M.D.

  • Gastroenterology Physician
  • Coon Rapids, MN
  • NPI 1750361283
  NPD (past)

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712016000000",
    "number": "1669496345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14909",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554140909",
            "telephone_number": "612-871-1145",
            "fax_number": "612-870-5491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 BROADWAY ST NE STE 500",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55413",
            "telephone_number": "612-871-1145",
            "fax_number": "612-870-5491"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5705 W Old Shakopee Rd Ste 150",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "MN",
            "postal_code": "554373126",
            "country_code": "US",
            "telephone_number": "612-871-1145",
            "fax_number": "612-870-5491",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "237 Radio Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Woodbury",
            "state": "MN",
            "postal_code": "551254478",
            "country_code": "US",
            "telephone_number": "612-871-1145",
            "fax_number": "612-870-5491",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9145 Springbrook Dr NW Ste 300",
            "address_purpose": "LOCATION",
            "city": "Coon Rapids",
            "state": "MN",
            "postal_code": "554335897",
            "country_code": "US",
            "telephone_number": "612-871-1145",
            "fax_number": "612-870-5491",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15700 37th Ave N Ste 300",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "MN",
            "postal_code": "554463661",
            "country_code": "US",
            "telephone_number": "612-871-1145",
            "fax_number": "612-870-5491",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1185 Town Centre Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Eagan",
            "state": "MN",
            "postal_code": "551231343",
            "country_code": "US",
            "telephone_number": "612-871-1145",
            "fax_number": "612-870-5491",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18465 Orchard Trl Ste 300",
            "address_purpose": "LOCATION",
            "city": "Lakeville",
            "state": "MN",
            "postal_code": "550442522",
            "country_code": "US",
            "telephone_number": "612-871-1145",
            "fax_number": "612-870-5491",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MNGI ENDOSCOPY ASC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A",
        "authorized_official_last_name": "KETOVER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-871-1145",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MN",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Minneapolis, MN
• Providers in Minneapolis, 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 Apr 2, 2024; 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.