Minnesota Personalized Medicine LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

MINNESOTA PERSONALIZED MEDICINE LLC

Practice address

1409 Willow St Ste 501
Minneapolis, MN 55403-3288

Phone

(612) 345-5029

Fax

(612) 392-3957

NPI assigned

Oct 7, 2021

Organization subpart

No

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

Authorized official

Name

Gregory A Plotnikoff, MD

Title

Owner/Founder

Phone

(612) 345-5029

Specialties & licenses 1

Addresses

Other identifiers 3

Electronic endpoints 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tara Katherine Doyle Bizily, MD

  • Family Medicine Physician
  • Minneapolis, MN
  • NPI 1962463737
  NPD
• Kathleen Grennan Hopkins, D.O.

  • Family Medicine Physician
  • Inver Grove Heights, MN
  • NPI 1346474509
  NPD (past)
• June Lavalleur, MD

  • Obstetrics & Gynecology Physician
  • Minneapolis, MN
  • NPI 1699855411
  NPD (past)
• Lisa Marie Terhaar, CNP

  • Gerontology Nurse Practitioner
  • Circle Pines, MN
  • NPI 1750684049
  NPD (past)

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

{
    "created_epoch": "1633564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633564800000",
    "number": "1760144679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 WILLOW ST STE 501",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554033288",
            "telephone_number": "612-345-5029",
            "fax_number": "612-392-3957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 WILLOW ST STE 501",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554033288",
            "telephone_number": "612-345-5029",
            "fax_number": "612-392-3957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA PERSONALIZED MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-07",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A",
        "authorized_official_last_name": "PLOTNIKOFF",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/FOUNDER",
        "authorized_official_telephone_number": "612-345-5029",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "34265",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "47498",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "43318",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "mnpersonalizedmedicine.md-hq.com",
            "affiliation": "N",
            "endpointDescription": "patient portal of EHR System",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1409 Willow St Ste 501",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554033288",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Medical Specialty Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; 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.