APPLE VALLEY MEDICAL CLINIC, LTD. (NPI# 1366754434) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366754434 |
| Entity Type | Organization |
| Organization Name | APPLE VALLEY MEDICAL CLINIC, LTD. |
| Practice Address |
14655 Galaxie Ave Apple Valley MN 55124-8575 |
| Practice Telephone | 9524326161 |
| Mailing Telephone | 9524326161 |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2017-06-19 |
| Authorized Official Name | MR. MARK POTTENGER (ADMINISTRATOR) |
| Authorized Official Telephone | 9529539285 |
| Is Organization Subpart | Y |
| Parent Organization Name | APPLE VALLEY MEDICAL CLINIC, LTD. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 723 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BLUEE CROSS BLUE SHIELD | 22345AP | 01 | |
| HEALTHPARTNERS | 55108 | 01 | |
| PREFERRED ONE | 858098 | 01 | |
| RAILROAD MEDICARE | CE7163 | 01 | |
| MEDICARE | 679251001 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346550555 | Apple Valley Medical Clinic, Ltd. | Family Medicine | 15100 Galaxie Ave, Apple Valley, MN 55124 | 2010-10-21 |
| 1477599918 | Apple Valley Medical Clinic, Ltd. | Family Medicine | 14655 Galaxie Ave, Apple Valley, MN 55124 | 2006-06-22 |
| Street Address |
14655 GALAXIE AVE |
| City | APPLE VALLEY |
| State | MN |
| Zip Code | 55124-8575 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316940042 | Imr of Mn., LLC | Clinic/Center | 14655 Galaxie Ave, Ste 160, Apple Valley, MN 55124-8575 | 2005-05-26 |
| 1760097976 | Allina Health System | Clinic/Center | 14655 Galaxie Ave, Apple Valley, MN 55124-8602 | 2020-09-14 |
| 1467087064 | Devon Simone Ellena | Nurse Practitioner | 14655 Galaxie Ave, Apple Valley, MN 55124-8602 | 2020-03-04 |
| 1437781333 | Nathaniel Vanloon | Physician Assistant | 14655 Galaxie Ave, Apple Valley, MN 55124-8602 | 2020-02-08 |
| 1790315273 | Sarah Barnes | Physician Assistant | 14655 Galaxie Ave, Apple Valley, MN 55124-8602 | 2020-01-23 |
| 1700427499 | Allina Health System | Emergency Medicine | 14655 Galaxie Ave, Apple Valley, MN 55124-8602 | 2019-10-03 |
| 1336620210 | Nicole Marie Lapage | Physician Assistant | 14655 Galaxie Ave, Apple Valley, MN 55124-8597 | 2018-08-28 |
| 1902390214 | Fairview Pharmacy Services LLC | Non-Pharmacy Dispensing Site | 14655 Galaxie Ave, Apple Valley, MN 55124-8602 | 2018-06-20 |
| 1063922516 | Julie Anne Rezac | Physician Assistant | 14655 Galaxie Ave, Apple Valley, MN 55124-8602 | 2017-10-10 |
| 1528507886 | Tammy Denise Johnston | Nurse Practitioner | 14655 Galaxie Ave, Apple Valley, MN 55124-8575 | 2017-02-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518574672 | Carol Susan Elstad | Counselor | Mn Mental Health Clinics, 15160 Foliage Ave Suite 140, Apple Valley, MN 55124 | 2020-09-23 |
| 1629612569 | Gadaa Care Transportation | Non-emergency Medical Transport (VAN) | 7296 157th St W, Apple Valley, MN 55124 | 2019-11-04 |
| 1356831515 | Dustin W Seabolt | Hearing Instrument Specialist | 15071 Dunwood Trl, Apple Valley, MN 55124 | 2018-05-14 |
| 1639687189 | Dentalign P.a. | Clinic/Center | 15875 Emperor Avenue, Apple Valley, MN 55124 | 2018-01-18 |
| 1982126926 | Apex Family Chiropractic LLC | Chiropractor | 15678 Pilot Knob Road, Suite 120, Apple Valley, MN 55124 | 2017-07-12 |
| 1821523028 | Robin Marie Parker | Nurse Practitioner | 14135 Cedar Avenue South, Suite 100, Apple Valley, MN 55124 | 2017-04-25 |
| 1134578826 | Ellen Denise Jacobson | Dentist | 14682 Pennock Avenue South, Apple Valley, MN 55124 | 2016-06-03 |
| 1831568708 | Clearriver Inc. | Home Health | 13790 Elkhart Rd, Apple Valley, MN 55124 | 2015-09-21 |
| 1265826879 | Next Level Fitness Co | Public Health or Welfare | 14645 Felton Ct, 104, Apple Valley, MN 55124 | 2015-03-20 |
| 1568872216 | Jon Butala | Marriage & Family Therapist | 4300 W 147th St., Suite 204, Apple Valley, MN 55124 | 2014-05-04 |
| Find all providers in zip 55124 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427567759 | Abigail Amrine | Family Medicine | 16167 Siskiyou Rd Ste A, Apple Valley, CA 92307-0837 | 2017-09-29 |
| 1518494541 | Empire Health Systems | Family Medicine | 15995 Tuscola Rd Ste 203, Apple Valley, CA 92307-2159 | 2017-05-22 |
| 1396147419 | Aaa Family Medical Group | Family Medicine | 15995 Tuscola Rd Ste 202, Apple Valley, CA 92307 | 2014-09-19 |
| 1295031052 | Desert Valley Medical Group, Inc. | Family Medicine | 19181 Town Center Dr, Apple Valley, CA 92308-8989 | 2011-01-26 |
| 1346550555 | Apple Valley Medical Clinic, Ltd. | Family Medicine | 15100 Galaxie Ave, Apple Valley, MN 55124 | 2010-10-21 |
| 1114235744 | Kenneth Grier | Family Medicine | 18564 Us Highway 18 Ste 101, Apple Valley, CA 92307-2320 | 2010-09-16 |
| 1831416742 | Bashar Mousa Shahatit | Family Medicine | 19341 Bear Valley Rd Ste 104, Apple Valley, CA 92308-5152 | 2010-05-02 |
| 1225232382 | John F Kuettner | Family Medicine | 13545 Hershey Ct, Apple Valley, MN 55124 | 2007-06-13 |
| 1912056177 | Jaime Cristobal David | Family Medicine | 18419 Outer Highway 18, Suite #6, Apple Valley, CA 92307 | 2007-01-09 |
| 1841353869 | Dan Vasile | Family Medicine | 18522 Us Highway 18 Ste 102, Apple Valley, CA 92307-2321 | 2006-12-19 |
| Find all providers in APPLE VALLEY | ||||
| City | APPLE VALLEY |
| Zip Code | 55124 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.