NPIMap

Organization Active NPI

Indian Health Board of Minneapolis, Inc

Doing business as IHB Minnehaha

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
National Provider Identifier
1760949168
Registry record updated May 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
INDIAN HEALTH BOARD OF MINNEAPOLIS, INC
Doing business as
IHB Minnehaha
Practice address
2101 Minnehaha Avenue South
Minneapolis, MN 55404-3107
Phone
(612) 721-9800
Fax
(612) 721-7870
NPI assigned
Feb 22, 2019
Last updated
May 27, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
INDIAN HEALTH BOARD OF MINNEAPOLIS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 27, 2021

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

Authorized official

Name
Patrick Rock, MD
Title
Ceo
Phone
(612) 721-9800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

2101 Minnehaha Avenue South
Minneapolis, MN 55404-3107

Mailing address

1315 E 24TH St Ste 1
Minneapolis, MN 55404-3959
Phone (612) 721-9830

Other identifiers 1

IdentifierTypeStateIssuer
1811999162MedicaidMN

Other names 1

  • IHB Minnehaha Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050825000069 MN Part B Supplier - Clinic/Group Practice 6002727849 Receives reassigned benefits from 24 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Minneapolis, MN
O20250527000397 MN Part A Provider - Federally Qualified Health Center (FQHC) 6002727849 Practice locations: Minneapolis, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760949168. Details of each certification follow.

Federally qualified health center certification: CCN 241005

Legal name
INDIAN HEALTH BOARD OF MINNEAPOLIS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 22, 2025
Last certification
May 22, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
2101 Minnehaha Ave
Minneapolis, MN 55404-3107

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Indian Health Board CLN2 organizations share this tax ID, including this one
Part of
Indian Health Board CLN

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1315 E 24th St
Ste 1
Minneapolis, MN 55404
Phone (612) 721-9800

2020 Minnehaha Ave
Minneapolis, MN 55404
Phone (612) 721-9800

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Heather Fahey Individual Corporate Director Apr 18, 2022
Joni M Buffalohead Individual Corporate DirectorBoard Member Oct 1, 2015
Frank D Broderick Individual Corporate DirectorBoard Member Aug 1, 2008
Gail Mason Individual Corporate Director Jan 3, 2024
Mark D Fiddler Individual Corporate Director Jul 1, 2014
Jason Luhrs Individual Corporate Director Dec 8, 2023
Lisa C Martin Individual Corporate Director Dec 1, 2015
Patrick M Rock Individual Corporate OfficerCeo Apr 3, 2007
W-2 Managing Employee Apr 3, 2007
Lemoine Lapointe Individual Corporate Director Sep 1, 2011
Linda Frizzell Individual Corporate Director Oct 15, 2017

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1550793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622073600000",
    "number": "1760949168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 E 24TH ST STE 1",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043959",
            "telephone_number": "612-721-9830",
            "fax_number": "612-721-7870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 MINNEHAHA AVENUE SOUTH",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043107",
            "telephone_number": "612-721-9800",
            "fax_number": "612-721-7870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN HEALTH BOARD OF MINNEAPOLIS, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INDIAN HEALTH BOARD OF MINNEAPOLIS, INC",
        "enumeration_date": "2019-02-22",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-27",
        "status": "A",
        "authorized_official_last_name": "ROCK",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "612-721-9800",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811999162",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IHB Minnehaha",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "IHB Minnehaha",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.