NPIMap

Organization Active NPI

Allina Health System

Doing business as Telepsychiatry Services

  • Behavioral Neurology & Neuropsychiatry Physician
  • Coon Rapids, MN
National Provider Identifier
1790286193
Registry record updated Feb 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavioral Neurology & Neuropsychiatry PhysicianTaxonomy code 2084B0040X
Legal business name
ALLINA HEALTH SYSTEM
Doing business as
Telepsychiatry Services
Practice address
4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522
Phone
(612) 262-1166
NPI assigned
Feb 22, 2018
Last updated
Feb 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2025

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

Authorized official

Name
Dominica Tallarico
Title
Coo
Phone
(612) 222-2222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavioral Neurology & Neuropsychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084B0040X Primary

Addresses

Primary practice location

4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522

Mailing address

PO Box 43
Mail Route 10585
Minneapolis, MN 55440-0043
Phone (612) 262-1166

Other names 1

  • Telepsychiatry Services Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service Other Ciox Health

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN, FL, CA, CO, NM, TX, PA, TN, GA, OR, VA, OH, IA14 enrollments

Enrollment records 14

Enrollment IDStateProvider typePAC IDDetails
O20031218000417 WI Part B Supplier - Clinic/Group Practice 4587573613 Receives reassigned benefits from 522 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baldwin, WI; River Falls, WI; Grantsburg, WI; Prescott, WI
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
O20171130000956 FL Part B Supplier - Clinic/Group Practice 4587573613 Receives reassigned benefits from 1 practitioner
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Inlet Beach, FL; West Palm Beach, FL; Temple Terrace, FL; Orlando, FL; Miramar, FL; Minneola, FL; Melbourne, FL; Largo, FL…
O20191022000010 CA Part B Supplier - Clinic/Group Practice 4587573613 Receives reassigned benefits from 2 practitioners
Practice locations: Foster City, CA; Los Angeles, CA
O20260219000048 CO Part B Supplier - Clinic/Group Practice 4587573613 Receives reassigned benefits from 1 practitioner
5 other NPIs on this enrollment
Practice locations: Boulder, CO; Salida, CO; Grand Junction, CO
O20260219001684 NM Part B Supplier - Clinic/Group Practice 4587573613 Receives reassigned benefits from 1 practitioner
Practice locations: Albuquerque, NM
O20260219004682 TX Part B Supplier - Clinic/Group Practice 4587573613 Receives reassigned benefits from 5 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cypress, TX; Temple, TX; Richmond, TX; McKinney, TX; Katy, TX; Houston, TX; Cedar Park, TX; Austin, TX…
O20260224000360 PA Part B Supplier - Clinic/Group Practice 4587573613 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
Practice locations: Camp Hill, PA; Lititz, PA
O20260331003143 TN Part B Supplier - Clinic/Group Practice 4587573613 Receives reassigned benefits from 1 practitioner
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Nashville, TN; Hermitage, TN; Chattanooga, TN; Columbia, TN
O20260401001824 GA Part B Supplier - Clinic/Group Practice 4587573613 Receives reassigned benefits from 1 practitioner
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Atlanta, GA; Barnesville, GA; Gainesville, GA; Snellville, GA
O20260401003686 OR Part B Supplier - Clinic/Group Practice 4587573613 Receives reassigned benefits from 2 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Beaverton, OR; Tigard, OR
O20260506002854 VA Part B Supplier - Clinic/Group Practice 4587573613 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Leesburg, VA; Penn Laird, VA
O20260508002801 OH Part B Supplier - Clinic/Group Practice 4587573613 Receives reassigned benefits from 1 practitioner
3 other NPIs on this enrollment
Practice locations: Westlake, OH; Sugarcreek, OH; Frazeysburg, OH; North Canton, OH; Dublin, OH
O20260511001163 IA Part B Supplier - Clinic/Group Practice 4587573613 Receives reassigned benefits from 1 practitioner
Practice locations: Pella, IA

Other NPIs on the same Medicare enrollment 22

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

View all 22

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

7373 France Ave S
Ste 204
Edina, MN 55435
Phone (952) 428-0500

280 Smith Ave N
Ste 450
Saint Paul, MN 55102
Phone (651) 241-5959

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
St Francis Regional Medical CenterShakopee, MN, CCN 240104 Hospital 5% Or Greater Direct Ownership Interest (47.5%) Nov 15, 2007
Courage Kenny Rehabilitation Institute TRPGolden Valley, MN, CCN 245519 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jun 1, 2013
Jun 1, 2013
Allina Health Restorative SuitesPlymouth, MN, CCN 245624 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 10, 2022

Practitioners & affiliated clinicians

Practitioners 41

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 41

NPI Registry JSON

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

{
    "created_epoch": "1519257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740441600000",
    "number": "1790286193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43",
            "address_2": "MAIL ROUTE 10585",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554400043",
            "telephone_number": "612-262-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332522",
            "telephone_number": "612-262-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLINA HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-22",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A",
        "authorized_official_last_name": "TALLARICO",
        "authorized_official_first_name": "DOMINICA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "612-222-2222"
    },
    "taxonomies": [
        {
            "code": "2084B0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.6635.1.1",
            "affiliationName": "Ciox Health",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "925 N Point Pkwy",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300055210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Telepsychiatry Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coon Rapids, MN

Sources for this page

Verify at the official NPI Registry.