COLUMBIA PARK MEDICAL GROUP, PA (NPI# 1932150117) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932150117 |
| Entity Type | Organization |
| Organization Name | COLUMBIA PARK MEDICAL GROUP, PA |
| Practice Address |
6401 University Ave Ne Suite 200 Fridley MN 55432-4341 |
| Practice Telephone | 7635725710 |
| Practice Fax Number | 7635713008 |
| Mailing Telephone | 7635725710 |
| Mailing Fax Number | 7635713008 |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2007-11-13 |
| Authorized Official Name | JOEN V CONDON (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 7635865839 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | 147 | MN | Allopathic & Osteopathic Physicians |
| N | 207K00000X | Allergy & Immunology | 147 | MN | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | 147 | MN | Allopathic & Osteopathic Physicians |
| N | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
147 | MN | Allopathic & Osteopathic Physicians |
| N | 207RI0200X |
Internal Medicine Specialization: Infectious Disease |
147 | MN | Allopathic & Osteopathic Physicians |
| N | 207V00000X | Obstetrics & Gynecology | 147 | MN | Allopathic & Osteopathic Physicians |
| N | 207W00000X | Ophthalmology | 147 | MN | Allopathic & Osteopathic Physicians |
| N | 207X00000X | Orthopaedic Surgery | 147 | MN | Allopathic & Osteopathic Physicians |
| N | 207Y00000X | Otolaryngology | 147 | MN | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | 147 | MN | Allopathic & Osteopathic Physicians |
| N | 2083X0100X |
Preventive Medicine Specialization: Occupational Medicine |
147 | MN | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | 147 | MN | Allopathic & Osteopathic Physicians |
| N | 208800000X | Urology | 147 | MN | Allopathic & Osteopathic Physicians |
| N | 208M00000X | Hospitalist | 147 | MN | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | 147 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | PREF ONE URGENT CARE # | 1014268 | 01 |
| MN | STATE PROF. REGISTRATION | 147 | 01 |
| MN | PREFERRED ONE | AQ9091045486 | 01 |
| MN | BCBS OF MN | 02071BR | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497847644 | Columbia Park Medical Group, Pa | Durable Medical Equipment & Medical Supplies | 10961 Club West Pkwy, Blaine, MN 55449-4671 | 2006-09-28 |
| 1558453787 | Columbia Park Medical Group, Pa | Durable Medical Equipment & Medical Supplies | 10000 Zane Ave N, Brooklyn Park, MN 55443-1400 | 2006-09-28 |
| 1649370396 | Columbia Park Medical Group, Pa | Pharmacy | 10000 Zane Ave N, Suite 100, Brooklyn Park, MN 55443-1400 | 2006-09-23 |
| 1609976570 | Columbia Park Medical Group, Pa | Durable Medical Equipment & Medical Supplies | 6341 University Ave Ne, Fridley, MN 55432-4946 | 2006-09-22 |
| 1942300801 | Columbia Park Medical Group, Pa | Durable Medical Equipment & Medical Supplies | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2006-09-22 |
| 1326148271 | Columbia Park Medical Group, Pa | Pharmacy | 4000 Central Ave Ne, Columbia Heights, MN 55421-2968 | 2006-09-22 |
| 1417056698 | Columbia Park Medical Group, Pa | Pharmacy | 13819 Hanson Blvd Nw, Suite 100, Andover, MN 55304-7608 | 2006-09-22 |
| 1326147505 | Columbia Park Medical Group, Pa | Eyewear Supplier (Equipment, not the service) | 13819 Hanson Blvd Nw, Andover, MN 55304-7608 | 2006-09-22 |
| 1700986668 | Columbia Park Medical Group, Pa | Durable Medical Equipment & Medical Supplies | 4000 Central Ave Ne, Columbia Heights, MN 55421-2968 | 2006-09-22 |
| 1619077575 | Columbia Park Medical Group, Pa | Eyewear Supplier (Equipment, not the service) | 4000 Central Ave Ne, Columbia Heights, MN 55421-2968 | 2006-09-22 |
| Street Address |
6401 UNIVERSITY AVE NE SUITE 200 |
| City | FRIDLEY |
| State | MN |
| Zip Code | 55432-4341 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669433207 | Cecil Emerson Bassett | Obstetrics & Gynecology | 6401 University Ave Ne, Fridley, MN 55432-4341 | 2006-03-31 |
| 1902430960 | Gloria Jean Nance | Community Health Worker | 6401 University Ave Ne, Fridley, MN 55432-4341 | 2020-02-28 |
| 1144616509 | Fairview Express Care | Internal Medicine | 6401 University Ave Ne, Second Floor, Fridley, MN 55432-4341 | 2015-04-13 |
| 1417365479 | Matthew Sorensen | Physical Therapist | 6401 University Ave Ne, Fridley, MN 55432-4341 | 2014-07-22 |
| 1922361328 | Amanda Kathryn Hilligoss | Physical Therapist | 6401 University Ave Ne, Fridley, MN 55432-4320 | 2012-06-20 |
| 1659674364 | John F. Bartels | Physical Therapist | 6401 University Ave Ne, Fridley, MN 55432-4341 | 2010-12-20 |
| 1073829750 | Amy Moore | Registered Nurse | 6401 University Ave Ne, Suite 100, Fridley, MN 55432-4341 | 2010-08-19 |
| 1295061935 | Deborah Lynn Elsen | Registered Nurse | 6401 University Ave Ne, #200, Fridley, MN 55432-4341 | 2009-10-31 |
| 1902039548 | Lisa Gail Brown | Dietitian, Registered | 6401 University Ave Ne, Suite 200, Fridley, MN 55432-4341 | 2009-08-31 |
| 1811123516 | Anthony J Flink | Physical Therapy Assistant | 6401 University Ave Ne, 105, Fridley, MN 55432-4341 | 2009-06-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336791177 | Adelyn Ruth Kopp | Occupational Therapist | 500 Osborne Rd Ne Suite 365, Fridley, MN 55432 | 2019-07-11 |
| 1831665603 | White Smiles Family Dentistry Pllc | Dentist | 1611 County Hwy 10, Minneapolis, MN 55432 | 2018-10-19 |
| 1518402213 | Peaceful Adult Day Center LLC. | Home Health | 6267 University Ave Ne, Fridley, MN 55432 | 2017-01-04 |
| 1205383742 | Farhiya Mahamud Gelle I | Durable Medical Equipment & Medical Supplies | 6329 5th Street Ne Apt 8, Fridley, MN 55432 | 2016-09-01 |
| 1093163164 | Christiane Schwecke | Specialist/Technologist | 8290 University Ave N, Fridley, MN 55432 | 2016-05-31 |
| 1336551563 | Amy White Mountain | Massage Therapist | 1611 County Hwy 10 Ne, Spring Lake Park, MN 55432 | 2014-05-22 |
| 1942629795 | Shane O'neil | Dermatology | 500 Osborne Rd Ne Ste 330, Fridley, MN 55432 | 2014-04-09 |
| 1952648180 | John Franklyn Marshall | Family Medicine | 480 Osborne Road Ne, Suite 100, Fridley, MN 55432 | 2013-01-08 |
| 1558610519 | Novacare Outpatient Rehabilitation East Inc | Clinic/Center | 480 Osborne Road, Number 280, Fridley, MN 55432 | 2012-09-06 |
| 1336423391 | Christian Restoration Services | Counselor | 7157 Commerce Circle W, Fridley, MN 55432 | 2011-10-07 |
| Find all providers in zip 55432 | ||||
| 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 |
|---|---|---|---|---|
| 1952648180 | John Franklyn Marshall | Family Medicine | 480 Osborne Road Ne, Suite 100, Fridley, MN 55432 | 2013-01-08 |
| 1912968546 | Barbara Anne Bank | Family Medicine | 6341 University Ave Ne, Fridley, MN 55432-4946 | 2006-03-31 |
| 1124087622 | Elise Christine Brodin Larson | Family Medicine | 5130 Main St Ne, Fridley, MN 55421-1528 | 2006-03-22 |
| 1497728661 | Nader Bishara Ailabouni | Family Medicine | 500 Osborne Rd Ne Ste 255, Fridley, MN 55432-2768 | 2006-02-08 |
| 1184606774 | Steven Duane Bentz | Family Medicine | 7675 Madison St Ne, Fridley, MN 55432-2753 | 2005-11-18 |
| 1407851694 | Crystal M Dexter | Family Medicine | 500 Osborne Rd Ne, Suite 255, Fridley, MN 55432-2774 | 2005-06-15 |
| 1437684602 | Alysse Victoria Cruz | Family Medicine | 500 Osborne Rd Ne Ste 255, Fridley, MN 55432-2768 | 2017-04-25 |
| 1619401270 | Betlehem Semahge | Family Medicine | 480 Osborne Rd Ne, Fridley, MN 55432-2773 | 2017-04-20 |
| 1568823870 | Diana Lynn Heilig | Family Medicine | 500 Osborne Rd Ne Ste 255, Fridley, MN 55432-2768 | 2016-03-14 |
| 1689067860 | Mona Abdel-bary | Family Medicine | 500 Osborne Rd Ne, Suite 255, Fridley, MN 55432-2765 | 2015-03-11 |
| Find all providers in FRIDLEY | ||||
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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.