OMNI MEDICAL CENTER PLLC (NPI# 1659845659) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659845659 |
| Entity Type | Organization |
| Organization Name | OMNI MEDICAL CENTER PLLC |
| Other Organization Name | OMNI COSMETIC |
| Practice Address |
935 Wayzata Blvd E Ste 200 Wayzata MN 55391-2513 |
| Practice Telephone | 7635594500 |
| Practice Fax Number | 7635591733 |
| Mailing Telephone | 7635594500 |
| Mailing Fax Number | 7635591733 |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2019-05-15 |
| Authorized Official Name | BRYAN NICHOLAS ROLFES (PHYSICIAN) |
| Authorized Official Telephone | 7635594500 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2082S0099X |
Plastic Surgery Specialization: Plastic Surgery Within the Head and Neck |
Allopathic & Osteopathic Physicians | ||
| Y | 208200000X | Plastic Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OTHER INS | 1659845659 | 01 |
| Other Name | Type Code |
|---|---|
| Omni Cosmetic | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 628 Roosevelt Rd Ste 102, Saint Cloud, MN 563014867 | 3207742411 | 7635591733 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851991079 | Omni Medical Center Pllc | Surgery | 935 Wayzata Blvd E Ste 200, Wayzata, MN 55391-2513 | 2020-10-27 |
| Street Address |
935 WAYZATA BLVD E STE 200 |
| City | WAYZATA |
| State | MN |
| Zip Code | 55391-2513 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124046933 | John A Ness | Surgery | 935 Wayzata Blvd E Ste 200, Wayzata, MN 55391-2513 | 2006-07-18 |
| 1851991079 | Omni Medical Center Pllc | Surgery | 935 Wayzata Blvd E Ste 200, Wayzata, MN 55391-2513 | 2020-10-27 |
| 1003453515 | Omni Facial Plastic Surgery | Plastic Surgery | 935 Wayzata Blvd E Ste 200, Wayzata, MN 55391-2513 | 2019-12-03 |
| 1558688366 | Bryan Nicholas Rolfes | Otolaryngology | 935 Wayzata Blvd E Ste 200, Wayzata, MN 55391-2513 | 2010-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790386456 | Alexandra Lloyd Conroy | Counselor | 3227 Lake Shore Boulevard, Minnetonka, MN 55391 | 2020-11-07 |
| 1417579178 | Kate Anne Schroeder | Behavioral Analyst | 901 Twelve Oaks Center Drive Suite 934, Wayzata, MN 55391 | 2020-05-15 |
| 1467940478 | Tyler Michael Knutson | Chiropractor | 1421 E Wayzata Blvd, Wayzata, MN 55391 | 2018-04-25 |
| 1427552025 | Emma Nadler, L.L.C. | Counselor | 700 Twelve Oaks Center Dr. #263, Wayzata, MN 55391 | 2018-03-20 |
| 1730687757 | Global Home Care Inc | Home Health | 1001 Twelve Oaks Center Drive, Suite 1018, Wayzata, MN 55391 | 2018-01-24 |
| 1205362472 | Oraphanh Vongpheth Smith | Registered Nurse | 801 Twelve Oaks Center Drive, Suite 822, Wayzata, MN 55391 | 2017-05-10 |
| 1386189272 | Wayzata Endodontics, P.a. | Dentist | 101 Lake Street West, Suite 100, Wayzata, MN 55391 | 2016-12-30 |
| 1952763351 | Watershed Psychological Services | Clinic/Center | 4255 Pheasant Ridge Drive, Suite 412, Blaine, MN 55391 | 2016-03-24 |
| 1477923571 | Robert J. Floren | Marriage & Family Therapist | 801 Twelve Oaks Center Dr Ste 816a, Wayzata, MN 55391 | 2015-10-01 |
| 1194101055 | Bruce Martinson Family & Cosmetic Dentistry | Dentist | 317 E Wayzata Blvd, Wayzata, MN 55391 | 2015-08-03 |
| Find all providers in zip 55391 | ||||
| Taxonomy Code | 208200000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Plastic Surgery |
| A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Plastic Surgery, 2007. http://www.abplsurg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Plastic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104252022 | Bashioum Cosmetic Surgery Center, Ltd. | Plastic Surgery | 445 Lake St E Ste 210, Wayzata, MN 55391-1671 | 2013-09-24 |
| 1710022363 | Peter Andrew Vogt | Plastic Surgery | 319 Barry Ave S, #300, Wayzata, MN 55391-1658 | 2007-02-21 |
| 1003453515 | Omni Facial Plastic Surgery | Plastic Surgery | 935 Wayzata Blvd E Ste 200, Wayzata, MN 55391-2513 | 2019-12-03 |
| 1578797916 | Peter A Vogt Md Pa | Plastic Surgery | 319 Barry Ave S, Suite 300, Wayzata, MN 55391-1658 | 2009-05-13 |
| 1194869941 | Ralph W Bashioum | Plastic Surgery | 445 Lake St E, Wayzata, MN 55391-1657 | 2007-02-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720574445 | Echelon Surgical Specialists LLC | Plastic Surgery | 15450 Highway 7 Ste 225, Minnetonka, MN 55345-3522 | 2018-07-05 |
| 1184994501 | James Jerome Diehl | Plastic Surgery | 10530 W Riverview Dr, Eden Prairie, MN 55347-4921 | 2012-01-02 |
| 1851690697 | Jason Dean Fowler | Plastic Surgery | 1420 London Rd Ste 101, Duluth, MN 55805-2437 | 2011-03-18 |
| 1093049348 | Harry Alvin Johnson Jr. | Plastic Surgery | 4708 Townes Road, Edina, MN 55424 | 2009-09-18 |
| 1013151430 | Jennifer Ann Cameron | Plastic Surgery | 310 Smith Ave N Ste 330, Saint Paul, MN 55102 | 2009-04-29 |
| 1538336938 | Oscar Javier Manrique Mogollon | Plastic Surgery | 5347 Scenic Oak Dr Sw, Rochester, MN 55902-2567 | 2008-05-14 |
| 1558533919 | David O. Smith | Plastic Surgery | 6545 France Ave S Ste 505, Edina, MN 55435-2116 | 2008-03-26 |
| 1447442702 | Sue-mi C Tuttle | Plastic Surgery | 401 Phalen Blvd-ms 41104h, Healthpartners Specialty Center 401, St. Paul, MN 55130-5302 | 2007-08-10 |
| 1033314943 | Tracy So Kayan | Plastic Surgery | 2805 Campus Dr Ste 485, Plymouth, MN 55441-2919 | 2007-06-19 |
| 1487733788 | Umeng David Thao | Plastic Surgery | 604 Bielenberg Dr, Suite 250, Woodbury, MN 55125-1414 | 2006-11-06 |
| 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.