Allina Health System
Organization Active NPI Physical Medicine & Rehabilitation Physician · Coon Rapids, MN
NPI 1770034670 · NPPES record last updated Feb 25, 2025
Key facts
- NPI
- 1770034670
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- Legal business name
- ALLINA HEALTH SYSTEM
- Practice address
- 11850 Blackfoot St NW Ste 405
Coon Rapids, MN 55433-2773 - Phone
- (763) 236-0888
- NPI assigned
- Oct 17, 2016
- Organization subpart
- No
Authorized official
- Name
- Dominica Tallarico
- Title
- Coo
- Phone
- (612) 222-2222
Practitioners 36
-
Melissa Baughman, DO
-
Jason Robert Darrah, M.D.
-
Elizabeth Marie Ezell, PA-C
-
Andrew F Fedor III, PHD LP
-
Tamara N. Fuller-Eddins, M.D.
-
Lorett Lynn Huffman, LICSW
-
Jessica Kappelman, LCSW
-
Molly Helen Ladwig, DNP, FNP-C, APRN
-
Lorraine Laroy, M.D.
-
Hoshmand Las, PA-C
-
Jennifer Lees, L.P.
-
John R. Lesser, MD
-
Liza Antoinette Jain Phu, M.D.
-
Amanda Kay Rynda, DNP, CNP
-
Casey N Sprague, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040319000460 | MN | Part B Supplier - Clinic/Group Practice | 4587573613 |
Receives reassigned benefits from 4,246 practitioners This NPI is an additional NPI on the enrollment |
| O20221213001713 | MN | Part B Supplier - Clinic/Group Practice | 4587573613 |
Receives reassigned benefits from 3,000 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician |
208100000X | Yes |
Addresses
Primary practice location
11850 Blackfoot St NW Ste 405
Coon Rapids, MN 55433-2773
Mailing address
PO Box 43
Mail Route 10585
Minneapolis, MN 55440-0043
Phone (612) 262-1166
Other names
- Courage Kenny Rehabilitation Associates
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service | Other | Ciox Health |
Other providers in Coon Rapids, MN
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
All providers in Coon Rapids, MN · Physical Medicine & Rehabilitation Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.