NPIMap

Organization Active NPI

Allina Health System

Doing business as Allina Health Urgent Care Champlin

  • Urgent Care Clinic/Center
  • Champlin, MN
National Provider Identifier
1801402722
Registry record updated Feb 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
ALLINA HEALTH SYSTEM
Doing business as
Allina Health Urgent Care Champlin
Practice address
11269 Jefferson Hwy N
Champlin, MN 55316-3123
Phone
(763) 236-0600
NPI assigned
Sep 16, 2020
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
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

11269 Jefferson Hwy N
Champlin, MN 55316-3123

Mailing address

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

Other names 1

  • Allina Health Urgent Care Champlin 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 MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory

Locations

2855 Campus Dr
Plymouth, MN 55441
Phone (763) 577-7000

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740441600000",
    "number": "1801402722",
    "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": "11269 JEFFERSON HWY N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553163123",
            "telephone_number": "763-236-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLINA HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-16",
        "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": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "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": "Allina Health Urgent Care Champlin",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Allina Health Urgent Care Champlin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Champlin, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.