Midwest Spine & Brain Institute, L.L.C.

Primary specialty

Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X

Legal business name

MIDWEST SPINE & BRAIN INSTITUTE, L.L.C.

Practice address

1950 Northwestern Ave S Ste 102
Stillwater, MN 55082-7615

Phone

(651) 430-3800

Fax

(651) 430-3827

NPI assigned

Jul 4, 2006

Reactivated

Oct 17, 2018

Organization subpart

No

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

Authorized official

Name

Shari Ohland, MHA, CMPE

Title

Administrator

Phone

(651) 430-3800

Specialties & licenses 4

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in MN, WI3 enrollments

Enrollment records 3

Locations

Practitioners 28

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

• David T Chang, MD

  • Neurological Surgery Physician
  • Roseville, MN
  • NPI 1336116052

  WI

  Medicare reassignment Care Compare group NPD
• Alyssa Page Edwards, NP

  • Adult Health Nurse Practitioner
  • Saint Paul, MN
  • NPI 1841737814

  WI

  Medicare reassignment Care Compare group NPD
• Todd Edward Jackman, MD

  • Orthopaedic Surgery of the Spine Physician
  • Edina, MN
  • NPI 1427259191

  WI

  Medicare reassignment Care Compare group NPD
• Eduardo J Perez, MD

  • Neurological Surgery Physician
  • Eau Claire, WI
  • NPI 1427049808

  MN

  Medicare reassignment Care Compare group NPD
• Matthew C Hawkins, P.A.-C.

  • Physician Assistant
  • Edina, MN
  • NPI 1043293673

  WI

  Medicare reassignment Care Compare group
• Glenn Robin Buttermann, M.D.

  • Orthopaedic Surgery Physician
  • Roseville, MN
  • NPI 1598712788

  Orthopaedic Surgery of the Spine, WI

  Medicare reassignment NPD
• Hart Phillip Garner, MD

  • Neurological Surgery Physician
  • Coon Rapids, MN
  • NPI 1497808422
  Medicare reassignment NPD
• Eric S Nussbaum, MD

  • Neurological Surgery Physician
  • Edina, MN
  • NPI 1306813092
  Medicare reassignment NPD
• Stefano M Sinicropi, MD

  • Orthopaedic Surgery of the Spine Physician
  • Edina, MN
  • NPI 1003894460

  WI

  Medicare reassignment NPD
• Jacob Gregory Guth, P.A.C

  • Physician Assistant
  • Stillwater, MN
  • NPI 1134169774

  WI

  Medicare reassignment
• Kylee N Persing, PA

  • Physician Assistant
  • Saint Paul, MN
  • NPI 1598364473

  WI

  Medicare reassignment
• Eric Sage Salman, P.A.C

  • Physician Assistant
  • Roseville, MN
  • NPI 1366488587

  WI

  Medicare reassignment

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552608000000",
    "number": "1902836133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 NORTHWESTERN AVE S STE 102",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550827615",
            "telephone_number": "651-430-3800",
            "fax_number": "651-430-3827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 NORTHWESTERN AVE S STE 102",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550827615",
            "telephone_number": "651-430-3800",
            "fax_number": "651-430-3827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST SPINE & BRAIN INSTITUTE, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2019-03-15",
        "deactivation_date": "2018-09-12",
        "reactivation_date": "2018-10-17",
        "status": "A",
        "authorized_official_last_name": "OHLAND",
        "authorized_official_first_name": "SHARI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "651-430-3800",
        "authorized_official_credential": "MHA, CMPE"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "115117",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "1M559MI",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32851500",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP10969",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "N004668",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "0900009",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620529100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "96425",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin Alexander Mennell, DMD
• Linda Sue Mercado, LMFT
• Kayla Marie Meyer, OT
• Laura J Meyer, NP
• Sarah Elizabeth Meyer, PA-C
• Lori Mildon, DPT
• Nancy Studtman Millard, PT
• Charles Roth Miller, MA, LPCC
• Erin Miller
• Kelli Jo Syltie Miller, PA-C

• Orthopaedic Surgery of the Spine Physician in Stillwater, MN
• Providers in Stillwater, MN by specialty
• Orthopaedic Surgery of the Spine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2019; 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.