INTEGRATED MED GROUP PLLC (NPI# 1609474998) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609474998 |
| Entity Type | Organization |
| Organization Name | INTEGRATED MED GROUP PLLC |
| Practice Address |
2781 Freeway Blvd Ste 160 Brooklyn Center MN 55430-1765 |
| Practice Telephone | 7635158799 |
| Practice Fax Number | 7632448021 |
| Mailing Telephone | 7635158799 |
| Mailing Fax Number | 7632448021 |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2020-10-09 |
| Authorized Official Name | JASON STADTHER (CEO/OWNER) |
| Authorized Official Telephone | 7635158799 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
Ambulatory Health Care Facilities |
| Street Address |
2781 FREEWAY BLVD STE 160 |
| City | BROOKLYN CENTER |
| State | MN |
| Zip Code | 55430-1765 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205205069 | Midwest Imaging LLP | Clinic/Center | 2781 Freeway Blvd Ste 160, Brooklyn Center, MN 55430-1765 | 2015-09-22 |
| 1801427380 | Joseph John Grahek | Massage Therapist | 2781 Freeway Blvd Ste 160, Brooklyn Center, MN 55430-1765 | 2020-02-03 |
| 1447890637 | Community Care Chiropractic @ Rehab Center, LLC | Chiropractor | 2781 Freeway Blvd Ste 160, Brooklyn Center, MN 55430-1765 | 2020-01-15 |
| 1932627684 | Icare Diagnostic Imaging LLC | Clinic/Center | 2781 Freeway Blvd Ste 160, Brooklyn Center, MN 55430-1765 | 2017-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396362182 | Graceland Homes | Home Health | 6843 Colfax Ave N, Brooklyn Center, MN 55430 | 2020-06-29 |
| 1912549742 | His Services Home Care, LLC | Home Health | 2108 70th Avenue North, Brooklyn Park, MN 55430 | 2019-10-14 |
| 1336612969 | Jeremiah Sk Pojah Sr. | Registered Nurse | 5201 Bryant Avenue North, Suite 108, Minneapolis, MN 55430 | 2019-01-07 |
| 1891219697 | Tamika Yvette Spicer | Home Health Aide | 6640 Humboldt Ave N, 101, Brooklyn Center, MN 55430 | 2017-08-02 |
| 1265973358 | James Contois | Community Based Residential Treatment Facility, Mental Illness | 6120 Earle Brown Drive, Suite 100, Brooklyn Center, MN 55430 | 2017-03-09 |
| 1336693746 | Sara Jean Cooper | Dentist | 1090 Shingle Creek Pkwy, Brooklyn Center, MN 55430 | 2016-08-15 |
| 1750732202 | Miriam Home Health Corporation | Residential Treatment Facility, Physical Disabilities | 7030 Humboldt Avenue North, Brooklyn Center, MN 55430 | 2016-06-27 |
| 1649628561 | Tranquility Health LLC | Community/Behavioral Health | 6040 Earle Brown Dr Ste 250, Brooklyn Center, MN 55430 | 2016-06-01 |
| 1104233790 | Lillie's Helping Hands | In Home Supportive Care | 6407 Camden Ave N, #303, Brooklyn Center, MN 55430 | 2014-07-16 |
| 1063760817 | Wal-mart Stores Inc | Technician/Technologist | 1200 Shingle Creek Crossing, Brooklyn Center, MN 55430 | 2012-08-28 |
| Find all providers in zip 55430 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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| 1922576081 | Complex Cares LLC | Clinic/Center | 4700 Lexington Ave N Ste C, Shoreview, MN 55126-5964 | 2018-11-07 |
| 1033565510 | Minnesota Disc Replacement and Spine Restoration Center | Clinic/Center | 4444 76 St, #700, Edina, MN 55435 | 2016-05-13 |
| 1992196307 | Austin Orthopedics & Sports Medicine | Clinic/Center | 14051 Burnhaven Dr Ste 100, Burnsville, MN 55337-4400 | 2015-02-08 |
| 1831599430 | Medifit Health, LLC | Clinic/Center | 9201 Quaday Ave Ne Ste 203, Otsego, MN 55330-6604 | 2014-09-02 |
| 1437567609 | Aligned Chiropractic Pa | Clinic/Center | 3408 E Lake St, Suite 120, Minneapolis, MN 55406-2175 | 2014-07-31 |
| 1316369911 | New Leaf Medical, Pllc | Clinic/Center | 3622 County Road 101 S, Wayzata, MN 55391-3424 | 2014-01-16 |
| 1861825093 | Active Feet, Foot & Ankle Health Center | Clinic/Center | 10995 Club West Pkwy Ste 300, Blaine, MN 55449-5861 | 2013-08-12 |
| 1841538808 | White Dandelion Chinese Medicine L.L.C. | Clinic/Center | 108 3rd St E, Northfield, MN 55057-2050 | 2013-01-27 |
| 1831409234 | Princeton Chiropractic Clinic LLC | Clinic/Center | 501 4th St S Ste 101, Princeton, MN 55371-4754 | 2010-10-19 |
| 1629252101 | Paula Allenburg, Ltd | Clinic/Center | 2415 Emerson Ave S, Minneapolis, MN 55405-2602 | 2007-12-20 |
| Find all providers with the same taxonomy | ||||
| City | BROOKLYN CENTER |
| Zip Code | 55430 |
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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.