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Hennepin County

Organization Active NPI Federally Qualified Health Center (FQHC) · Minneapolis, MN

NPI 1992276000 · NPPES record last updated Dec 19, 2018

Key facts

NPI
1992276000
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
HENNEPIN COUNTY
Practice address
2740 1St Ave S
Minneapolis, MN 55408-1611
Phone
(612) 348-5553
Fax
(612) 377-3299
NPI assigned
Dec 16, 2018
Organization subpart
No

Authorized official

Name
Stephanie Abel
Title
Area Manager
Phone
(612) 348-8824

Owned or controlled facilities with NPI records 16

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 14

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

Corporate family (same tax ID) 25

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

Practitioners 132

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

View all 132

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MN

Federally qualified health center certification: CCN 241882

Legal name
HENNEPIN COUNTY
Doing business as
SIMPSON SHELTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 5, 2019
Last certification
Feb 5, 2019
Ownership / control type
For profit – corporation
Organization structure
Government · Non-profit
Incorporated
Sep 19, 1989 in MN
Enrollment address
2740 1St Ave S
Minneapolis, MN 55408-1611

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Elizabeth David
Individual 		Corporate Director
Deputy County Administrator - Healt		 Jun 1, 2018 100%
Stephanie Abel
Individual 		W-2 Managing Employee
Director		 Jun 1, 2018 100%
Bao Vang
Individual 		Corporate Officer
Senior Administrative Manager		 Jul 1, 2022 100%
W-2 Managing Employee
Senior Administrative Manager		 Jul 1, 2022 100%

All facility ownership & control disclosures 15

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Hennepin County Medical Center
Minneapolis, MN · CCN 240004		 Hospital Operational/Managerial Control (100%) Nov 29, 2006
Hennepin County Medical Center
Minneapolis, MN · CCN 24T004		 Hospital Operational/Managerial Control (100%) Nov 29, 2006
Hennepin County Medical Center
Minneapolis, MN · CCN 24S004		 Hospital Operational/Managerial Control (100%) Nov 29, 2006
Mvna
Minneapolis, MN · CCN 247008		 Home health agency Operational/Managerial Control (100%) Nov 29, 2006
Hennepin County
Minneapolis, MN · CCN 241801		 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 1990
Northpoint Health & Wellness Center
Minneapolis, MN · CCN 241861		 Federally qualified health center Operational/Managerial Control Nov 2, 2010
Northpoint Pyc Clinic
Minneapolis, MN · CCN 241862		 Federally qualified health center Operational/Managerial Control Nov 2, 2010
Northpoint Olson Middle School
Minneapolis, MN · CCN 241869		 Federally qualified health center Operational/Managerial Control Sep 1, 2014
Northpoint Workforce Center Clinic
Minneapolis, MN · CCN 241873		 Federally qualified health center Other (100%) Jan 1, 1968
Northpoint Franklin Middle School
Minneapolis, MN · CCN 241877		 Federally qualified health center Other (100%) Jan 1, 1968
People Serving People
Minneapolis, MN · CCN 241885		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 19, 1987
Sep 19, 1987
Youthlink
Minneapolis, MN · CCN 241879		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 19, 1987
Sep 19, 1977
Catholic Charities Higher Ground
Minneapolis, MN · CCN 241880		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 19, 1987
Salvation Army Harbor Light Center
Minneapolis, MN · CCN 241881		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 19, 1987
Endeavors
Minneapolis, MN · CCN 241899		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 19, 1987
Sep 19, 1987

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040218001012 MN Part B Supplier - Clinic/Group Practice 7911892849 Receives reassigned benefits from 194 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Minneapolis, MN
O20190205002653 MN Part a Provider - Federally Qualified Health Center (FQHC) 7911892849 Practice locations: Minneapolis, MN

National Provider Directory

Tax ID family
Hennepin County Medical Ctr (26 organizations share this tax ID)

Locations

2740 1st Ave S
Minneapolis, MN 55408

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

2740 1St Ave S
Minneapolis, MN 55408-1611

Mailing address

525 Portland Ave # Mc963
Minneapolis, MN 55415-1533
Phone (612) 348-5553

Other names

  • Simpson Shelter Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 19, 2018.

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545177600000",
    "number": "1992276000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 PORTLAND AVE # MC963",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151533",
            "telephone_number": "612-348-5553",
            "fax_number": "612-377-6299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 1ST AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554081611",
            "telephone_number": "612-348-5553",
            "fax_number": "612-377-3299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENNEPIN COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-16",
        "last_updated": "2018-12-19",
        "status": "A",
        "authorized_official_last_name": "ABEL",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "AREA MANAGER",
        "authorized_official_telephone_number": "612-348-8824"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Simpson Shelter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

All providers in Minneapolis, MN · Federally Qualified Health Center (FQHC) in Minnesota

Sources for this page

Verify at the official NPI Registry.