Individual provider Active NPI

Matthew Renken, LADC

  • Professional Counselor
  • Fridley, MN
National Provider Identifier
1689147654
Registry record updated Apr 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
4234 Issued in MN
Practice address
520 Osborne Rd NE Ste 210
Fridley, MN 55432-2718
Phone
(763) 236-3800
Fax
(763) 236-3821
NPI assigned
Jan 2, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 4234 MN Primary

Addresses

Primary practice location

520 Osborne Rd NE Ste 210
Fridley, MN 55432-2718

Mailing address

PO Box 206
Minneapolis, MN 55480-0206
Phone (612) 262-9000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241119004774 MN Practitioner - Mental Health Counselor 7214462837 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

520 Osborne Rd NE
Suite 210
Fridley, MN 55432-2718
Phone (763) 236-3800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Jan 6, 2025 Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System CurrentSince Jan 6, 2025 Accepting new patients

Locations

520 Osborne Rd NE
Ste 210
Fridley, MN 55432
Phone (763) 236-3800

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

Interoperability endpoints

  • Direct secure messaging: mrenken679951@excellian.direct.allina.com

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1546387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743465600000",
    "number": "1689147654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 206",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554800206",
            "telephone_number": "612-262-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 OSBORNE RD NE STE 210",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322718",
            "telephone_number": "763-236-3800",
            "fax_number": "763-236-3821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENKEN",
        "first_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-02",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "4234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fridley, MN

Sources for this page

Verify at the official NPI Registry.