NPIMap

Organization Active NPI

Valley Pain Relief and Wellness Center, PLLC

  • Psychologist
  • Burnsville, MN
National Provider Identifier
1851922819
Registry record updated Feb 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
VALLEY PAIN RELIEF AND WELLNESS CENTER, PLLC
Practice address
2428 E 117TH St
Burnsville, MN 55337-1269
Phone
(612) 444-3000
NPI assigned
Jan 29, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2020

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

Authorized official

Name
Ashwin Vinod GeorgeNPI 1518169713
Title
VP, Ceo
Phone
(612) 444-3000

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

2428 E 117TH St
Burnsville, MN 55337-1269

Mailing address

2428 E 117TH St
Burnsville, MN 55337-1269
Phone (612) 444-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140321001462 MN Part B Supplier - Clinic/Group Practice 7517198211 Receives reassigned benefits from 19 practitioners
1 other NPI on this enrollment
Practice locations: Burnsville, MN; Woodbury, MN; St Louis Park, MN; Rochester, MN; Minneapolis, MN; Bemidji, MN; Plymouth, MN

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 1

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

National Provider Directory

National Provider Directory

Locations

403 4th St NW
Ste 140
Bemidji, MN 56601

2440 E 117th St
Burnsville, MN 55337
Phone (651) 331-8478

2428 E 117th St
Burnsville, MN 55337

2200 E Franklin Ave
Ste 199
Minneapolis, MN 55404

25 16th St NE
Rochester, MN 55906
Phone (507) 218-4773

4201 Excelsior Blvd
St Louis Park, MN 55416
Phone (952) 564-3880

1789 Woodlane Dr
Ste A
Woodbury, MN 55125

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1580256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582848000000",
    "number": "1851922819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2428 E 117TH ST",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553371269",
            "telephone_number": "612-444-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2428 E 117TH ST",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553371269",
            "telephone_number": "612-444-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY PAIN RELIEF AND WELLNESS CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-29",
        "last_updated": "2020-02-28",
        "certification_date": "2020-02-28",
        "status": "A",
        "authorized_official_last_name": "GEORGE",
        "authorized_official_first_name": "ASHWIN",
        "authorized_official_middle_name": "VINOD",
        "authorized_official_title_or_position": "VP, CEO",
        "authorized_official_telephone_number": "612-444-3000"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2020; 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.