MINNESOTA CENTER FOR OBESITY, METABOLISM & ENDOCRINOLOGY, PA (NPI# 1164477709) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164477709 |
| Entity Type | Organization |
| Organization Name | MINNESOTA CENTER FOR OBESITY, METABOLISM & ENDOCRINOLOGY, PA |
| Other Organization Name | MNCOME, PA |
| Practice Address |
1185 Town Centre Dr Suite 220 Eagan MN 55123-1187 |
| Practice Telephone | 6513791600 |
| Practice Fax Number | 6513791650 |
| Mailing Telephone | 6513791600 |
| Mailing Fax Number | 6513791650 |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2013-02-06 |
| Authorized Official Name | REBECCA GONZALEZ-CAMPOY (COO) |
| Authorized Official Telephone | 6513791600 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 1591 | MN | Allopathic & Osteopathic Physicians |
| Y | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
1591 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | HEALTHPARTNERS | 96386 | 01 |
| MN | RR MEDICARE | DB4333 | 01 |
| MN | 410654700 | 05 | |
| MN | BLUE CROSS BLUE SHIELD | 547S0MI | 01 |
| MN | MEDICARE PTAN | C03334 | 01 |
| MN | UCARE | 165867H314 | 01 |
| Other Name | Type Code |
|---|---|
| MNCOME, PA | Other Name - Individual/Organization |
| Street Address |
1185 TOWN CENTRE DR SUITE 220 |
| City | EAGAN |
| State | MN |
| Zip Code | 55123-1187 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578566840 | Charles E. Crutchfield IIi | Specialist | 1185 Town Centre Dr, Ste 101, Eagan, MN 55123-1188 | 2005-05-31 |
| 1518583590 | Virginia Otey Villarreal | Registered Nurse | 1185 Town Centre Dr, Eagan, MN 55123-1187 | 2020-06-24 |
| 1639510845 | Anna Lynn Connelly | Specialist/Technologist | 1185 Town Centre Dr, Suite 100, Eagan, MN 55123-1187 | 2013-07-16 |
| 1639326861 | Pamela O Strobel | Physician Assistant | 1185 Town Centre Dr, Suite 220, Eagan, MN 55123-1187 | 2008-08-19 |
| 1952587099 | Adam S. Kim | Internal Medicine | 1185 Town Centre Dr, Suite 200, Eagan, MN 55123-1187 | 2008-01-19 |
| 1225134240 | Vernon Claude Jesse | Psychologist | 1185 Town Centre Dr, Suite 225, Eagan, MN 55123-1186 | 2006-09-16 |
| 1215033238 | Mark Patrick Kerekes | Psychiatry & Neurology | 1185 Town Centre Dr, Suite 225 Bhsi LLC, Eagan, MN 55123-1186 | 2006-09-16 |
| 1962426502 | Crutchfield Dermatology, P.a. | Dermatology | 1185 Town Centre Dr, Suite 101, Eagan, MN 55123-1187 | 2006-07-27 |
| 1720033640 | Joseph Michael Gonzalez-campoy | Internal Medicine | 1185 Town Centre Dr, Suite 220, Eagan, MN 55123-1187 | 2006-05-23 |
| 1831144609 | Ayesha Ebrahim | Internal Medicine | 1185 Town Centre Dr, Suite 220, Eagan, MN 55123-1187 | 2006-05-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053828467 | Hilltop Family Chiropractic Center Pa | Chiropractor | 1121 Town Centre Drive Suite 202, Eagan, MN 55123 | 2018-01-08 |
| 1922452507 | Jacob Zimmerman | Counselor | 3450 O'leary Ln., Eagan, MN 55123 | 2016-04-20 |
| 1316320971 | K-squared Fitness, L.L.C. | Public Health or Welfare | 1100 Cliff Rd, Eagan, MN 55123 | 2015-07-01 |
| 1346683687 | Joshua M Dorn | Allergy & Immunology | 3460 Promenade Ave, Eagan, MN 55123 | 2013-04-16 |
| 1700172350 | Mary Christine Mcnabney | Nurse Practitioner | 610 Opperman Drive, D4 Health Center, Your Wellbeing Health Center, Eagan, MN 55123 | 2011-06-22 |
| 1033353669 | Todd Borstad | Social Worker | 3450 O'leary Lane, Eagan, MN 55123 | 2009-04-27 |
| 1821025271 | Mngi Endoscopy LLC | Clinic/Center | 1185 Town Centre Drive, Eagan, MN 55123 | 2006-06-28 |
| 1780620120 | Cindy Eileen Wood | Audiologist | 3440 Oleary Lane, 240, Eagan, MN 55123 | 2006-06-22 |
| 1609845742 | Jeffery R Dichter | Internal Medicine | 849 Govern Circle, Saint Paul, MN 55123 | 2006-03-14 |
| 1891269155 | Elise Broderick Quam | Social Worker | 3450 Oleary Ln, Eagan, MN 55123 | 2019-01-18 |
| Find all providers in zip 55123 | ||||
| Taxonomy Code | 207RE0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Endocrinology, Diabetes & Metabolism |
| An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. |
| 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 |
|---|---|---|---|---|
| 1720033640 | Joseph Michael Gonzalez-campoy | Internal Medicine | 1185 Town Centre Dr, Suite 220, Eagan, MN 55123-1187 | 2006-05-23 |
| 1831144609 | Ayesha Ebrahim | Internal Medicine | 1185 Town Centre Dr, Suite 220, Eagan, MN 55123-1187 | 2006-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538697818 | Mohammed Nmn Ahmed | Internal Medicine | 9055 Spring Brook Drive, Allina Coon Rapids Clinic 9055, Coon Rapids, MN 55433 | 2017-05-31 |
| 1174865570 | Sarang Patel | Internal Medicine | 401 Phalen Blvd # 41103d, Saint Paul, MN 55130 | 2013-03-23 |
| 1538395496 | Jacklyn Mae Ellickson | Internal Medicine | 401 Phalen Bl Vd, Ms 41103d, St Paul, MN 55130-5302 | 2009-06-05 |
| 1821245960 | Columba Alphonsus Gorman | Internal Medicine | 2607 Merrihills Dr Sw, Rochester, MN 55902-1168 | 2008-08-20 |
| 1861547382 | Lawrence D Schuster | Internal Medicine | 4999 France Ave S Ste 255, Minneapolis, MN 55410-1734 | 2007-01-24 |
| 1497804496 | Christopher Mark Schoonover | Internal Medicine | 255 Smith Avenue No #100, United Medical Specialties, St. Paul, MN 55102 | 2007-01-09 |
| 1235225160 | Charles John Billington | Internal Medicine | Minneapolis Vamc, Metabolic Section (111g), One Veterans Drive, Minneapolis, MN 55417 | 2006-10-05 |
| 1376651786 | Nacide Ercan-fang | Internal Medicine | Mpls Va Medical Center One Veterans Drive, 111g Endocrine/metabolic, Minneapolis, MN 55417 | 2006-08-26 |
| 1891703005 | Sindhu M. Devani | Internal Medicine | 1900 Centracare Dr #2500, Centracare Clinic- Health Plaza Specialties/endocrinolo, St Cloud, MN 56303 | 2006-08-03 |
| 1508806811 | Sidney Amos Jones | Internal Medicine | 111 Hundertmark Rd Ste 115n, Chaska, MN 55318-1584 | 2006-06-07 |
| Find all providers with the same taxonomy | ||||
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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.