LTC PROFESSIONALS PLLC (NPI# 1417251935) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417251935 |
| Entity Type | Organization |
| Organization Name | LTC PROFESSIONALS PLLC |
| Practice Address |
7801 E Bush Lake Rd Ste 400 Minneapolis MN 55439-3113 |
| Practice Telephone | 9522833161 |
| Practice Fax Number | 8669917241 |
| Mailing Telephone | 9522833161 |
| Enumeration Date | 2010-12-23 |
| Last Update Date | 2019-01-17 |
| Authorized Official Name | SIMON MITTAL (CEO) |
| Authorized Official Telephone | 5073639367 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | 20837 | MN | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 20837 | MN | Allopathic & Osteopathic Physicians |
| Y | 207R00000X | Internal Medicine | 42701 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | MEDICARE NPI | 1629038377 | 01 |
| MN | MEDICARE NPI | 1801814504 | 01 |
| Street Address |
7801 E BUSH LAKE RD STE 400 |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55439-3113 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215936216 | Kristen O Hansberry | Family Medicine | 7801 E Bush Lake Rd Ste 400, Minneapolis, MN 55439-3113 | 2005-07-20 |
| 1568925634 | Maggie Marie Prunty | Registered Nurse | 7801 E Bush Lake Rd Ste 400, Minneapolis, MN 55439-3113 | 2019-04-07 |
| 1700393436 | Barbara Agbo | Nurse Practitioner | 7801 E Bush Lake Rd Ste 400, Minneapolis, MN 55439-3113 | 2018-01-03 |
| 1992086383 | Anne Florence Wairimu Njenga | Nurse Practitioner | 7801 E Bush Lake Rd Ste 400, Minneapolis, MN 55439-3113 | 2011-08-30 |
| 1083870646 | Elizabeth Bachorik | Nurse Practitioner | 7801 E Bush Lake Rd Ste 400, Minneapolis, MN 55439 | 2008-08-04 |
| 1114183894 | Lisa Lee Cummings | Podiatrist | 7801 E Bush Lake Rd Ste 400, Minneapolis, MN 55439 | 2008-08-01 |
| 1265699698 | Lisa Renee Shields | Nurse Practitioner | 7801 E Bush Lake Rd Ste 400, Minneapolis, MN 55439 | 2008-05-22 |
| 1609040054 | Erin Phaedra Emerson Egginton | Family Medicine | 7801 E Bush Lake Rd Ste 400, Minneapolis, MN 55439-3113 | 2008-04-16 |
| 1588856546 | Marlene Bonilla Alicea | Podiatrist | 7801 E Bush Lake Rd Ste 400, Minneapolis, MN 55439 | 2007-08-14 |
| 1225058670 | Sherief A Mikhail | Preventive Medicine | 7801 E Bush Lake Rd Ste 400, Minneapolis, MN 55439-3113 | 2006-07-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538773601 | Bryan James Jaquette | Specialist/Technologist | Alina Health, 8100 West 78th Street, Suite 225, Edina, MN 55439 | 2020-09-04 |
| 1063034411 | Joseph E Noble | Marriage & Family Therapist | 7801 East Bush Lake Road, Suite 130, Edina, MN 55439 | 2020-05-08 |
| 1316421050 | Global Kinetics Usa Corporation | Physiological Laboratory | 5810 West 78th Street, Suite 210, Bloomington, MN 55439 | 2018-09-19 |
| 1003361601 | Zainab Ismail Hassan | Community Health Worker | 5400 W. 70th St # 207, Edina, MN 55439 | 2016-08-24 |
| 1861852287 | Global Linguistics Inc | Interpreter | 5535 Oak Glen Rd, Edina, MN 55439 | 2016-02-26 |
| 1063889616 | Lindsey Mackereth | Counselor | 7117 Ohms Ln, Edina, MN 55439 | 2015-08-31 |
| 1851706105 | Holly Beth Gaudreau | Specialist/Technologist | 8100 W 78th St., Suite 225, Edina, MN 55439 | 2014-06-25 |
| 1841504792 | Michelle R Aumock | Physician Assistant | 8100 W 78th Street, Ste 230, Edina, MN 55439 | 2010-08-03 |
| 1770812174 | Heather Lynn Hanson Grudzinski | Counselor | 7400 Metro Blvd #100-6, Edina, MN 55439 | 2009-12-14 |
| 1548599319 | Catasys Health Minnesota, Inc. | Case Management | 7825 Washington Avenue South, Suite 500, Pmb# 600-005, Bloomington, MN 55439 | 2009-12-08 |
| Find all providers in zip 55439 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861032054 | David Gregg | Internal Medicine | 5305 Humboldt Ave S, Minneapolis, MN 55419 | 2020-01-15 |
| 1316454077 | Independent Medical Clinic Pa | Internal Medicine | 2639 Nicollet Ave Ste 120, Minneapolis, MN 55408-1629 | 2018-01-03 |
| 1669905618 | Joseph Douglas Steffens | Internal Medicine | 701 Park Avenue, Internal Medicine Residency Program, Hennepin County Medical Center, Minneapolis, MN 55415 | 2017-04-06 |
| 1841650306 | Megan Mcgovern | Internal Medicine | 701 Park Ave # O1.340, Minneapolis, MN 55415-1623 | 2016-02-26 |
| 1700266079 | Jacob Wagner | Internal Medicine | D638 Mayo Building, 420 Delaware St Se, Minneapolis, MN 55455 | 2015-06-02 |
| 1659750503 | Melissa Ann Plesac | Internal Medicine | 500 Harvard St Se # 741, Minneapolis, MN 55455 | 2015-05-26 |
| 1033503040 | Elizabeth Stanton Teter Aby | Internal Medicine | 406 Harvard St Se # Mmc36, Minneapolis, MN 55455-0362 | 2015-03-27 |
| 1780002592 | Annie M Jacobsen | Internal Medicine | 701 Park Avenue South--medicine, Hennepin County Medical Center, Minneapolis, MN 55415-1829 | 2014-03-31 |
| 1386066173 | Michael Usher | Internal Medicine | 420 Delaware Street, Se, Mmc 741, Division of General Internal Medicine, Minneapolis, MN 55455 | 2014-01-13 |
| 1356684609 | Anteneh Girma Zewde | Internal Medicine | 87 Orlin Ave Se, Minneapolis, MN 55414-3560 | 2013-04-04 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55439 |
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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.