Organization Active NPI

Medica Health Management, LLC

Doing business as Integrated Care by Medica

  • Nurse Practitioner
  • Minnetonka, MN
National Provider Identifier
1750655882
Registry record updated Nov 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
21268142 Issued in MN
Legal business name
MEDICA HEALTH MANAGEMENT, LLC
Doing business as
Integrated Care by Medica
Practice address
401 Carlson Pkwy
Minnetonka, MN 55305-5359
Phone
(952) 992-2000
Fax
(952) 992-8665
NPI assigned
Mar 7, 2012
Last updated
Nov 20, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2013

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

Authorized official

Name
Mr. Glenn Andis
Title
Sr. Vice President Gov. Programs
Phone
(952) 992-3977

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 21268142 MN Primary

Addresses

Primary practice location

401 Carlson Pkwy
Minnetonka, MN 55305-5359

Mailing address

401 Carlson Pkwy
Minnetonka, MN 55305-5359
Phone (952) 992-2000

Other names 1

  • Integrated Care by Medica Doing business as

National Provider Directory

National Provider Directory

Locations

401 Carlson Pkwy
Minnetonka, MN 55305
Phone (952) 992-3404

401 Carlson Pkwy
#340
Minnetonka, MN 55305
Phone (952) 992-3581

401 Carlson Pkwy
#345
Minnetonka, MN 55305
Phone (952) 992-3581

401 Carlson Pkwy
#435
Minnetonka, MN 55305
Phone (952) 992-3581

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1331078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384905600000",
    "number": "1750655882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 CARLSON PKWY",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055359",
            "telephone_number": "952-992-2000",
            "fax_number": "952-992-8665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 CARLSON PKWY",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055359",
            "telephone_number": "952-992-2000",
            "fax_number": "952-992-8665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICA HEALTH MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-07",
        "last_updated": "2013-11-20",
        "status": "A",
        "authorized_official_last_name": "ANDIS",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "SR. VICE PRESIDENT GOV. PROGRAMS",
        "authorized_official_telephone_number": "952-992-3977",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "21268142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrated Care by Medica",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minnetonka, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.