NPIMap

Organization Active NPI

Diamond Lake Clinic, P.C.

  • Health Service Clinic/Center
  • Minneapolis, MN
National Provider Identifier
1740669498
Registry record updated Apr 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
52657 Issued in MN
Legal business name
DIAMOND LAKE CLINIC, P.C.
Practice address
5939 Portland Ave
Minneapolis, MN 55417-3127
Phone
(612) 806-3011
NPI assigned
May 27, 2015
Last updated
Apr 1, 2025By the provider in NPPES
Organization subpart
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

Authorized official

Name
Chukwuemeka Alexander Anyake, MD/MBBSNPI 1144495185
Title
Physician
Phone
(612) 806-3011

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 52657 MN Primary
Adult Mental Health Clinic/Center 261QM0850X 53530 MN
Primary Care Clinic/Center 261QP2300X 52657 MN
Point of Service 305S00000X 52657 MN

Addresses

Primary practice location

5939 Portland Ave
Minneapolis, MN 55417-3127

Mailing address

5939 Portland Ave
Minneapolis, MN 55417-3127
Phone (612) 806-3011

Other practice location 1

1497 White Bear Ave N
Saint Paul, MN 55106-2414
Phone (612) 869-4444

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150827002511 MN Part B Supplier - Clinic/Group Practice 8022324664 Receives reassigned benefits from 17 practitioners
Practice locations: Minneapolis, MN

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2279169Diamond Lake Clinic5939 Portland Ave S, Minneapolis, MN 55417Certificate of waiverMar 29, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1432684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743465600000",
    "number": "1740669498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5939 PORTLAND AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554173127",
            "telephone_number": "612-806-3011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5939 PORTLAND AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554173127",
            "telephone_number": "612-806-3011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1497 White Bear Ave N",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551062414",
            "country_code": "US",
            "telephone_number": "612-869-4444",
            "fax_number": "612-254-8244",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DIAMOND LAKE CLINIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-27",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A",
        "authorized_official_last_name": "ANYAKE",
        "authorized_official_first_name": "CHUKWUEMEKA",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "612-806-3011",
        "authorized_official_credential": "MD/MBBS"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "MN",
            "license": "52657",
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "MN",
            "license": "53530",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MN",
            "license": "52657",
            "primary": false
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "MN",
            "license": "52657",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2025; 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.