Allina Health System
Organization Active NPI Orthopaedic Surgery Physician · Faribault, MN
NPI 1972006807 · NPPES record last updated Feb 26, 2025
Key facts
- NPI
- 1972006807
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- Legal business name
- ALLINA HEALTH SYSTEM
- Practice address
- 35 State Ave Ste 1
Faribault, MN 55021-6369 - Phone
- (507) 497-3528
- NPI assigned
- Mar 16, 2018
- Organization subpart
- No
Authorized official
- Name
- Dominica Tallarico
- Title
- Coo
- Phone
- (612) 222-2222
Practitioners 68
-
Jennifer S Auge, MD
-
Corinne Laura Benson, CNP
-
Curtis L Binder, MD
-
Nicole P Blackwood, CRNP
-
Renea Brown, RN, CPNP
-
Bayard Chandler Carlson, M.D.
-
Charles Braxton Davis, M.D.
-
Kelly Johanna Dicke, APRN, CNP
-
Alan Divine, M.D.
-
Leah Duvor, D.O.
-
Timothy J Flynn, D.O
-
Rebekah Agnes Ann Fraser, FNP-C
-
Christopher JG Gordon, PA-C
-
Kevin M Harris, MD
-
Kristen Elizabeth Helvig, M.D.
-
Jami Jeyn Hughes, PSY.D, BCBA-D
-
Amr Idris, M.D.
-
Lizabeth Kaku, MD
-
Aaron Kaye, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040319000460 | MN | Part B Supplier - Clinic/Group Practice | 4587573613 |
Receives reassigned benefits from 4,246 practitioners This NPI is an additional NPI on the enrollment |
| O20221213001713 | MN | Part B Supplier - Clinic/Group Practice | 4587573613 |
Receives reassigned benefits from 3,000 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
Locations
800 E 28th St
Ste 1750
Minneapolis, MN 55407
Phone (612) 863-4495
1324 5th St N
New Ulm, MN 56073
Phone (507) 217-5000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | Yes | ||
| Orthopaedic Surgery of the Spine Physician |
207XS0117X | |||
| Podiatrist |
213E00000X |
Addresses
Primary practice location
35 State Ave Ste 1
Faribault, MN 55021-6369
Mailing address
PO Box 43
Mail Route 10585
Minneapolis, MN 55440-0043
Phone (612) 262-1166
Other names
- Allina Health Orthopedic, Podiatry and Spine Clinic-Faribault
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service | Other | Ciox Health |
Other providers in Faribault, MN
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Allina Health System
- Marisa A Amacher
- Barbara Anderson
- Cindy Anderson
- Dean Steven Anderson
- Jesse Michael Anderson
All providers in Faribault, MN · Orthopaedic Surgery Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.