NPIMap

Organization Active NPI

Portages Health LLC

  • Prescribing (Medical) Psychologist
  • Minneapolis, MN
National Provider Identifier
1942945761
Registry record updated May 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prescribing (Medical) PsychologistTaxonomy code 103TP0016X
Legal business name
PORTAGES HEALTH LLC
Practice address
310 4TH Ave S Ste 5010
Minneapolis, MN 55415-1053
Phone
(320) 492-2232
NPI assigned
May 5, 2022
Last updated
May 5, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2022

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

Authorized official

Name
Leonard Read Sulik, MDNPI 1083664130
Title
Sole MBR
Phone
(320) 492-2232

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
Prescribing (Medical) PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP0016X Primary

Addresses

Primary practice location

310 4TH Ave S Ste 5010
Minneapolis, MN 55415-1053

Mailing address

310 4TH Ave S Ste 5010
Minneapolis, MN 55415-1053

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230222002907 MN Part B Supplier - Clinic/Group Practice 6800269861 Receives reassigned benefits from 8 practitioners
Practice locations: Minneapolis, MN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1651708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651708800000",
    "number": "1942945761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 4TH AVE S STE 5010",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 4TH AVE S STE 5010",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151053",
            "telephone_number": "320-492-2232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTAGES HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-05",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-05",
        "status": "A",
        "authorized_official_last_name": "SULIK",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_middle_name": "READ",
        "authorized_official_title_or_position": "SOLE MBR",
        "authorized_official_telephone_number": "320-492-2232",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; 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.