NPIMap

Organization Active NPI

Minnesota Diagnostic Imaging Partners, LLC

Doing business as Maple Grove Imaging Center

  • Diagnostic Radiology Physician
  • Maple Grove, MN
National Provider Identifier
1922009471
Registry record updated Nov 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MINNESOTA DIAGNOSTIC IMAGING PARTNERS, LLC
Doing business as
Maple Grove Imaging Center
Practice address
9855 Hospital Drive
#105
Maple Grove, MN 55369-4776
Phone
(763) 559-2171
Fax
(763) 398-4401
NPI assigned
Aug 9, 2005
Last updated
Nov 15, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
MINNESOTA DIAGNOSTIC IMAGING PARTNERS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 15, 2019

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

Authorized official

Name
Kristen Carlson
Title
Credentialing
Phone
(763) 398-2207

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

9855 Hospital Drive
#105
Maple Grove, MN 55369-4776

Mailing address

9855 Hospital Drive
#150
Maple Grove, MN 55369-4776
Phone (763) 559-2171

Other identifiers 3

IdentifierTypeStateIssuer
420012800MedicaidMN
342S2MIOtherBCBS
1601988OtherMEDICA

Other names 1

  • Maple Grove Imaging Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080227000847 MN Part B Supplier - Clinic/Group Practice 5890681209 Receives reassigned benefits from 49 practitioners
Practice locations: Maple Grove, MN; Robbinsdale, MN; Plymouth, MN; Crystal, MN

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
24D1044699North Memorial Imaging Center - Maple Grove9855 Hospital Drive Suite 150, Maple Grove, MN 55369Certificate of waiverDec 4, 2026

National Provider Directory

National Provider Directory
Part of
Minnesota Diagnostic Imaging Partners LLC

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

9855 Hospital Dr
#105
Maple Grove, MN 55369
Phone (763) 559-2171

9855 Hospital Dr
Ste 150
Maple Grove, MN 55369
Phone (763) 398-6341

2800 Campus Dr
Ste 20
Plymouth, MN 55441
Phone (763) 398-8700

Practitioners & affiliated clinicians

Practitioners 53

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 53

NPI Registry JSON

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573776000000",
    "number": "1922009471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9855 HOSPITAL DRIVE",
            "address_2": "#150",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694776",
            "telephone_number": "763-559-2171",
            "fax_number": "763-398-6364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9855 HOSPITAL DRIVE",
            "address_2": "#105",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694776",
            "telephone_number": "763-559-2171",
            "fax_number": "763-398-4401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA DIAGNOSTIC IMAGING PARTNERS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MINNESOTA DIAGNOSTIC IMAGING PARTNERS, LLC",
        "enumeration_date": "2005-08-09",
        "last_updated": "2019-11-15",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "763-398-2207"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420012800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "342S2MI",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "1601988",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maple Grove Imaging Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Maple Grove Imaging Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maple Grove, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.