Premier Physical Healthcare PLLC

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

29671 Issued in MN

Legal business name

PREMIER PHYSICAL HEALTHCARE PLLC

Practice address

115 W Howard St
Hibbing, MN 55746-1548

Phone

(218) 262-3315

Fax

(218) 263-9648

NPI assigned

Jan 3, 2012

Organization subpart

No

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

Authorized official

Name

John Ryan Michaels

Title

Owner

Phone

(218) 262-3315

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kristine Elizabeth Michaels, D.C.

  • Chiropractor
  • Hibbing, MN
  • NPI 1528326220
  Medicare reassignment NPD
• Daniel Scott Vechell, M.D.

  • Diagnostic Radiology Physician
  • Hibbing, MN
  • NPI 1275634628
  Medicare reassignment NPD

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

{
    "created_epoch": "1325548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351641600000",
    "number": "1811267214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 W HOWARD ST",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557461548",
            "telephone_number": "218-262-3315",
            "fax_number": "218-263-9648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 W HOWARD ST",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557461548",
            "telephone_number": "218-262-3315",
            "fax_number": "218-263-9648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PHYSICAL HEALTHCARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-03",
        "last_updated": "2012-10-31",
        "status": "A",
        "authorized_official_last_name": "MICHAELS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-262-3315"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MN",
            "license": "29671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MN",
            "identifier": "1811267214",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811267214",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gina Marie Pettinari, CRNA
• Kimberly Dawn Pettinelli, NP
• PJ Noss LLC
• Bernadette J Pospeck, MSW, LICSW
• Richard A Pounds, MD
• Sara Procopio, LADC
• Michael John Quirk, DC
• Radical Wellness LLC
• Radiological Associates of Duluth
• Radiologists Associated in Duluth LTD

• Sports Medicine (Family Medicine) Physician in Hibbing, MN
• Providers in Hibbing, MN by specialty
• Sports Medicine (Family Medicine) Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2012; 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.