Allina Health System
Organization Active NPI Behavioral Neurology & Neuropsychiatry Physician · Coon Rapids, MN
NPI 1790286193 · NPPES record last updated Feb 25, 2025
Key facts
- NPI
- 1790286193
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Behavioral Neurology & Neuropsychiatry Physician 2084B0040X
- Legal business name
- ALLINA HEALTH SYSTEM
- Practice address
- 4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522 - Phone
- (612) 262-1166
- NPI assigned
- Feb 22, 2018
- Organization subpart
- No
Authorized official
- Name
- Dominica Tallarico
- Title
- Coo
- Phone
- (612) 222-2222
Other NPIs on the same Medicare enrollment 22
Member of 1
Practitioners 41
-
Nicholas D. Crall, D.O.
-
Jose Francisco Rodriguez, PMHNP
-
Sophie Claire Feller, M.D.
-
Ryan Hargraves, M.D.
-
Maura Rossye Munoz, M.D.
-
Jennifer Ann Argentieri, M.D.
-
Leah Marie Benson, D.O.
-
Lauren Jan Brettingen, B.S., MPAS
-
Trent Christensen, M.D.
-
Rachelle N. Damle, M.D.
-
Sydney Eckert, MS
-
Maria Fulton, DNP
-
Danielle Gilbertson, MSW, LICSW
-
Gregory Hatfield, M.D.
-
Daniel Brian Hurley, PH.D., LP
-
Marta Khan, PA-C
-
Kushal R Parikh, MD
-
Robert Penrod, M.D.
-
Jennifer R Riggs, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (14 enrollments) in WI, MN, FL, CA, CO, NM, TX, PA, TN, GA, OR, VA, OH, IA
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| St Francis Regional Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest (47.5%) | Nov 15, 2007 |
| Courage Kenny Rehabilitation Institute TRP |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Jun 1, 2013 Jun 1, 2013 |
| Allina Health Restorative Suites |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Nov 10, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavioral Neurology & Neuropsychiatry Physician |
2084B0040X | Yes |
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
- Telepsychiatry Services
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 · Behavioral Neurology & Neuropsychiatry 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.