NPIMap

Organization Active NPI

Indian Health Board of Minneapolis, Inc

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
National Provider Identifier
1811999162
Registry record updated Jan 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
6115875 Issued in MN
Legal business name
INDIAN HEALTH BOARD OF MINNEAPOLIS, INC
Practice address
1315 E 24TH St
Minneapolis, MN 55404-3975
Phone
(612) 721-9800
Fax
(612) 721-7870
NPI assigned
Jun 1, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2011

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

Authorized official

Name
Dr. Patrick Rock, M.D.NPI 1235134354
Title
Ceo
Phone
(612) 721-9881

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 6115875 MN Primary

Addresses

Primary practice location

1315 E 24TH St
Minneapolis, MN 55404-3975

Mailing address

1315 E 24TH St
Minneapolis, MN 55404-3975
Phone (612) 721-9800

Other identifiers 12

IdentifierTypeStateIssuer
844522200MedicaidMN
916817600MedicaidMN
946883800MedicaidMN
634930700MedicaidMN
730320300MedicaidMN
781137300MedicaidMN
138488100MedicaidMN
934633300MedicaidMN
125028100MedicaidMN
206817600MedicaidMN
996488600MedicaidMN
942317600MedicaidMN

Other names 1

  • Indian Health Board of Minneapolis, Inc Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030725000017 MN Part A Provider - Federally Qualified Health Center (FQHC) 6002727849 Practice locations: Minneapolis, MN
O20050825000069 MN Part B Supplier - Clinic/Group Practice 6002727849 Receives reassigned benefits from 24 practitioners
2 other NPIs on this enrollment
Practice locations: Minneapolis, MN

Federally qualified health center certification: CCN 241805

Legal name
INDIAN HEALTH BOARD OF MINNEAPOLIS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 1, 1992
Last certification
Jul 1, 1992
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Nov 3, 1971 in MN
Enrollment address
1315 E 24TH St
Minneapolis, MN 55404-3975

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

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
24D0401355Indian Health Board of Minneapolis1315 E 24TH St, Minneapolis, MN 55404AccreditationApr 29, 2028

National Provider Directory

National Provider Directory

Locations

1315 E 24th St
Fl 3
Minneapolis, MN 55404

2020 Minnehaha Ave
Minneapolis, MN 55404
Phone (612) 721-9800

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Heather Fahey Individual W-2 Managing EmployeeBoard Member Secretary Apr 18, 2022
Joni M Buffalohead Individual Corporate DirectorBoard Member Oct 1, 2015
Frank D Broderick Individual Corporate DirectorBoard Member Aug 1, 2008
Gail Mason Individual Corporate Director Jan 3, 2024
Mark D Fiddler Individual Corporate DirectorBoard Member Jul 1, 2014
Jason Luhrs Individual Corporate Director Dec 8, 2023
Lisa C Martin Individual Corporate DirectorBoard Member Dec 1, 2015
Patrick M Rock Individual W-2 Managing EmployeeCeo Apr 3, 2007 100%
Jessica Budd Individual W-2 Managing EmployeeRevenue Manager Mar 28, 2022
Lemoine Lapointe Individual Corporate DirectorBoard Member Sep 1, 2011
Linda Frizzell Individual Corporate Director Oct 15, 2017

Owners & managing parties with NPI records 1

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

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295395200000",
    "number": "1811999162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 E 24TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043975",
            "telephone_number": "612-721-9800",
            "fax_number": "612-721-7870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 E 24TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043975",
            "telephone_number": "612-721-9800",
            "fax_number": "612-721-7870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN HEALTH BOARD OF MINNEAPOLIS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-01",
        "last_updated": "2011-01-19",
        "status": "A",
        "authorized_official_last_name": "ROCK",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "612-721-9881",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MN",
            "license": "6115875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "844522200",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "916817600",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "946883800",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "634930700",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "730320300",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "781137300",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "138488100",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "934633300",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125028100",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206817600",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "996488600",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "942317600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian Health Board of Minneapolis, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.