LIFESPRK MEDICAL GROUP, PA (NPI# 1427551746) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427551746 |
| Entity Type | Organization |
| Organization Name | LIFESPRK MEDICAL GROUP, PA |
| Other Organization Name | LIFESPRK HEALTH |
| Practice Address |
5320 W 23rd St Ste 130 St Louis Park MN 55416-1670 |
| Practice Telephone | 9523458770 |
| Practice Fax Number | 9523458871 |
| Mailing Telephone | 9523453213 |
| Mailing Fax Number | 9523458871 |
| Enumeration Date | 2018-03-13 |
| Last Update Date | 2020-11-04 |
| Authorized Official Name | CATHERINE ANN LAURING (CEO) |
| Authorized Official Telephone | 9523453213 |
| Authorized Official Credential | APRN, CNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
2385 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Lifesprk Health | Doing Business As Name - Organization |
| Street Address |
5320 W 23RD ST STE 130 |
| City | ST LOUIS PARK |
| State | MN |
| Zip Code | 55416-1670 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467440784 | Leann Clarksean | Nurse Practitioner | 5320 W 23rd St Ste 130, St Louis Park, MN 55416-1670 | 2005-10-11 |
| 1295379154 | Lifesprk Hospice, LLC | Hospice Care, Community Based | 5320 W 23rd St Ste 130, St Louis Park, MN 55416-1670 | 2019-11-04 |
| 1225684616 | Joanna Weinand | Dietitian, Registered | 5320 W 23rd St Ste 130, St Louis Park, MN 55416-1670 | 2019-08-13 |
| 1407223282 | Lifesprk Home Health LLC | Home Health | 5320 W 23rd St Ste 130, St Louis Park, MN 55416-1670 | 2015-08-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639711492 | Ismahan Abdirahman Mohamed | Psychologist | 4236 Parkglen Rd, St Louis Park, MN 55416 | 2019-10-14 |
| 1598307860 | Ayman Abulaziz Mohamed | Counselor | 4326 Park Glen Rd, St Louis Park, MN 55416 | 2019-10-08 |
| 1831758929 | Ally Group Homes LLC | Assisted Living Facility | 2944 Princeton Ave South, Saint Louis Park, MN 55416 | 2019-06-11 |
| 1609371525 | Heather Margaret Flatgard | Chiropractor | 5407 Excelsior Blvd Ste D, St Louis Park, MN 55416 | 2018-03-25 |
| 1942702394 | Polaris Pharmacy Services of Minnesota, LLC | Pharmacy | 4220 Park Glen Road, St. Louis Park, MN 55416 | 2018-03-01 |
| 1316469760 | Evert Ray Boyd | Psychologist | 3200 Highway 100 S., Groves Academy, St Louis Park, MN 55416 | 2017-07-07 |
| 1861941684 | Amanda Marie Tapper | Marriage & Family Therapist | 5407 Excelsior Blvd, Suite B, St Louis Park, MN 55416 | 2016-09-22 |
| 1326410416 | Clear Health Chiropractic LLC | Chiropractor | 5614 W 36th St, St. Louis Park, MN 55416 | 2015-10-28 |
| 1568897833 | Kay Elizabeth Lichtenberger | Physical Therapist | 4415 W 36.5 St, St. Louis Park, MN 55416 | 2013-09-05 |
| 1710221510 | Aaron Christopher Oppelt | Counselor | 1665 Utica Ave South - Suite 100, Saint Louis Park, MN 55416 | 2012-11-16 |
| Find all providers in zip 55416 | ||||
| Taxonomy Code | 207QG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Geriatric Medicine |
| A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. |
| 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 Family Medicine, 2007. http://wwwtheabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://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 Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821065533 | Jeffrey K Larkin | Family Medicine | 3800 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2006-03-01 |
| 1346227287 | Jennifer Olson | Family Medicine | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2005-12-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942766423 | Moments Palliative Care LLC | Family Medicine | 820 Lilac Dr N Ste 210, Golden Valley, MN 55422-4754 | 2019-02-20 |
| 1588137640 | Wayforth Clinical Services LLC | Family Medicine | 401 Harding St Ne Ste 200, Minneapolis, MN 55413-2801 | 2019-01-10 |
| 1891174751 | Hra-iq PC | Family Medicine | 4600 W 77th St, #355, Edina, MN 55435-4909 | 2015-05-26 |
| 1477943421 | Optum Medical Services of Colorado, P.C. | Family Medicine | 13625 Technology Dr, Eden Prairie, MN 55344-2252 | 2015-01-29 |
| 1811139264 | Charles D Townes | Family Medicine | 16 Meadow Ln S, Minneapolis, MN 55416-3403 | 2009-04-01 |
| 1447203187 | Ruth O Szajner | Family Medicine | 701 Park Ave # S5, Minneapolis, MN 55415-1623 | 2006-05-17 |
| 1093702235 | Asma Khalid | Family Medicine | 621 S 4th St, Le Sueur, MN 56058-2203 | 2005-10-03 |
| 1750917985 | Marisa L Felker | Family Medicine | 270 Main St N Ste 300, Stillwater, MN 55082-6788 | 2020-03-19 |
| 1588028161 | Joshua M Baruth | Family Medicine | 200 1st St Sw, Rochester, MN 55905-0001 | 2016-04-08 |
| 1528458486 | Optum Medical Services of California, P.C. | Family Medicine | 13625 Technology Dr, Eden Prairie, MN 55344-2252 | 2015-01-30 |
| Find all providers with the same taxonomy | ||||
| City | ST LOUIS PARK |
| Zip Code | 55416 |
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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.