NPIMap

Organization Active NPI

Illumia Health LLC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • White Bear Lake, MN
National Provider Identifier
1972316289
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
Legal business name
ILLUMIA HEALTH LLC
Practice address
3580 Linden Ave Ste A1
White Bear Lake, MN 55110-4625
Phone
(704) 664-2876
Fax
(704) 230-0946
NPI assigned
Jan 30, 2025
Last updated
May 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

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

Authorized official

Name
Janet L. Combs
Title
VP of Licensure
Phone
(704) 662-1761

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X Primary

Addresses

Primary practice location

3580 Linden Ave Ste A1
White Bear Lake, MN 55110-4625

Mailing address

PO Box 4060
Attn: Regulatory
Mooresville, NC 28117-4060
Phone (704) 664-2876

Other practice location 1

350 S 5th St
Minneapolis, MN 55415-1316
Phone (704) 664-2876

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250708000799 MN Part B Supplier - Clinic/Group Practice 7810424306 Receives reassigned benefits from 6 practitioners
Practice locations: White Bear Lake, MN

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Illumia Health LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Member of 2

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

Locations

3508 Professional Cir
Ste A1
Augusta, GA 30907
Phone (706) 993-4108

350 S 5th St
Minneapolis, MN 55415

1718 Indian Wood Cir
Ste A1
Maumee, OH 43537
Phone (419) 482-1050

Practitioners & affiliated clinicians

Practitioners 71

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 71

NPI Registry JSON

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

{
    "created_epoch": "1738195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1972316289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4060",
            "address_2": "ATTN: REGULATORY",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281174060",
            "telephone_number": "704-664-2876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3580 LINDEN AVE STE A1",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551104625",
            "telephone_number": "704-664-2876",
            "fax_number": "704-230-0946"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 S 5th St",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554151316",
            "country_code": "US",
            "telephone_number": "704-664-2876",
            "fax_number": "704-230-0946",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ILLUMIA HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-30",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "COMBS",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "VP OF LICENSURE",
        "authorized_official_telephone_number": "704-662-1761"
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in White Bear Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2025; 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.