NPIMap

Organization Active NPI

Neighborhood Healthsource

Doing business as Central Clinic

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
National Provider Identifier
1811934763
Registry record updated Jun 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NEIGHBORHOOD HEALTHSOURCE
Doing business as
Central Clinic
Practice address
2301 Central Ave NE
Minneapolis, MN 55418
Phone
(612) 588-9411
Fax
(612) 781-3837
NPI assigned
Jun 1, 2006
Last updated
Jun 29, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2023

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

Authorized official

Name
Mr. Steve J Knutson
Title
Executive Director
Phone
(612) 588-9411

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
General Practice Physician 208D00000X NU

Addresses

Primary practice location

2301 Central Ave NE
Minneapolis, MN 55418

Mailing address

2301 Central Ave NE
Minneapolis, MN 55418
Phone (612) 588-9411

Other names 1

  • Central Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040729000231 MN Part B Supplier - Clinic/Group Practice 9133199953 Receives reassigned benefits from 16 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Coon Rapids, MN; Minneapolis, MN
O20080218000610 MN Part A Provider - Federally Qualified Health Center (FQHC) 9133199953 Practice locations: Minneapolis, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811934763. Details of each certification follow.

Federally qualified health center certification: CCN 241821

Legal name
NEIGHBORHOOD HEALTHSOURCE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 20, 1996
Last certification
Mar 20, 1996
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jun 18, 1975 in MN
Enrollment address
2301 Central Neave
Minneapolis, MN 55418-3709
Related CCNs
241813

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0402086Neighborhood Health Source Central Avenue Clinic2301 Central Avenue NE, Minneapolis, MN 55418ComplianceOct 25, 2026

National Provider Directory

National Provider Directory
Tax ID family
Fremont Community HLTH SVCS2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Curt J Engels Individual Corporate OfficerFinance Director Jul 24, 2023
W-2 Managing EmployeeFinance Director Jul 24, 2023
Philip Denny Individual Corporate DirectorBoard Member Jun 1, 2024
Mayte Cambara Individual Corporate DirectorBoard Member Jun 1, 2024
Steven J Knutson Individual Corporate DirectorExecutive Director Mar 1, 2009 100%
W-2 Managing EmployeeExecutive Director Mar 1, 2009
Gloria J Peterson Individual Corporate DirectorBoard Member Jun 1, 2024
Carroll Barnes Individual Corporate DirectorBoard Member Jun 1, 2024
Nathan Ebnet Individual Corporate DirectorBoard Member Jun 1, 2024
Doug Christensen Individual Corporate DirectorBoard Member Jun 1, 2024
Victor Wong Individual Corporate DirectorBoard Member Jun 1, 2024
Roberta Ridyn Kelley Individual Corporate DirectorBoard Member Jun 1, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687996800000",
    "number": "1811934763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 CENTRAL AVE NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55418",
            "telephone_number": "612-588-9411",
            "fax_number": "612-781-3837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 CENTRAL AVE NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55418",
            "telephone_number": "612-588-9411",
            "fax_number": "612-781-3837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEIGHBORHOOD HEALTHSOURCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A",
        "authorized_official_last_name": "KNUTSON",
        "authorized_official_first_name": "STEVE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "612-588-9411",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Central Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.