OPTUM INFUSION SERVICES 500, INC. (NPI# 1699251520) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699251520 |
| Entity Type | Organization |
| Organization Name | OPTUM INFUSION SERVICES 500, INC. |
| Practice Address |
2685 Patton Rd Roseville MN 55113 |
| Mailing Address |
2685 Patton Rd Roseville MN 55113-1137 |
| Practice Telephone | 6514358142 |
| Practice Fax Number | 8448909906 |
| Mailing Telephone | 9133356787 |
| Mailing Fax Number | 8555789497 |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2020-03-06 |
| Authorized Official Name | EDWARD PAUL KRAMM (CEO) |
| Authorized Official Telephone | 9137473705 |
| Is Organization Subpart | Y |
| Parent Organization Name | AXELACARE, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332BP3500X |
Durable Medical Equipment & Medical Supplies Specialization: Parenteral & Enteral Nutrition |
Suppliers | ||
| N | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
Suppliers | ||
| Y | 3336H0001X |
Pharmacy Specialization: Home Infusion Therapy Pharmacy |
Suppliers |
| Other Name | Type Code |
|---|---|
| BriovaRx Infusion Services, Inc. | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265904924 | Optum Infusion Services 500, Inc. | Durable Medical Equipment & Medical Supplies | 1893 General George Patton Drive, Suite 100, Franklin, TN 37067 | 2018-12-19 |
| 1326520206 | Optum Infusion Services 500, Inc. | Durable Medical Equipment & Medical Supplies | 5627 University Heights, Ste. 105, San Antonio, TX 78249 | 2018-09-06 |
| 1437649456 | Optum Infusion Services 500, Inc. | Pharmacy | 19 Chapin Road, Building D, Suite D7, Pine Brook, NJ 07058-9385 | 2018-05-15 |
| 1699262808 | Optum Infusion Services 500, Inc. | Durable Medical Equipment & Medical Supplies | 4900 Rivergrade Rd Ste E120, Irwindale, CA 91706-1419 | 2018-04-13 |
| 1780187237 | Optum Infusion Services 500, Inc. | Durable Medical Equipment & Medical Supplies | 8888 Interchange Dr Rm 119, Houston, TX 77054-2512 | 2018-03-12 |
| 1093228306 | Optum Infusion Services 500, Inc. | Pharmacy | 33 N Plains Industrial Rd, Wallingford, CT 06492-5841 | 2017-11-08 |
| 1205363777 | Optum Infusion Services 500, Inc. | Durable Medical Equipment & Medical Supplies | 2182 Dividend Drive, Columbus, OH 43228 | 2017-05-16 |
| 1407394588 | Optum Infusion Services 500, Inc. | Pharmacy | 8400 Esters Blvd Ste 185, Rm 119, Irving, TX 75063 | 2017-02-08 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Iowa Business Entities | OPTUM INFUSION SERVICES 500, INC. | 15529 College Blvd, Lenexa, KS 66219 |
| Colorado Business Entities | Optum Infusion Services 500, Inc. | 15529 College Blvd, Lenexa, KS 66219 |
| Street Address |
2685 PATTON RD |
| City | ROSEVILLE |
| State | MN |
| Zip Code | 55113 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396384376 | Zachary Mattson | Physician Assistant | Regus Coworking Space 2355 Highway 36 West, Suite 400, Office #427, Roseville, MN 55113 | 2019-12-23 |
| 1467010330 | Ahmed Issa | Student in an Organized Health Care Education/Training Program | 1550 Larpenteur Ave W, Apt 235, St Paul, MN 55113 | 2019-06-05 |
| 1821653833 | Suite Living Senior Care of Little Canada | Assisted Living Facility | 2740 Rice Street, Little Canada, MN 55113 | 2019-05-06 |
| 1902370505 | Diverse Assessments and Treatment, LLC | Psychologist | 1935 Cty Rd B2 W Ste 270, Roseville, MN 55113 | 2019-01-16 |
| 1588138473 | Applewood Home Health Care, LLC | Home Health | 2021 E Hennepin Avenue # 402-1, Minneapolis, MN 55113 | 2019-01-14 |
| 1083104145 | Suite Living Senior Care of Roseville | Assisted Living Facility | 197 County Road B2 W, Roseville, MN 55113 | 2018-05-15 |
| 1477055796 | Sunrise Residential Services LLC | Home Health | 216 Maple Ln, Roseville, MN 55113 | 2018-03-02 |
| 1194223024 | Alissa Hoff | Specialist | 1595 Mn 36 - 584 10 Rosedale Center, Roseville, MN 55113 | 2018-01-25 |
| 1841705118 | Kingsland Care Services Incorporated | Case Management | 2301 Rice Street, Suite 101, Roseville, MN 55113 | 2017-12-08 |
| 1558872010 | Nafisa A Elmi | Dentist | 1700 Highway 36 W Ste 860, Roseville, MN 55113 | 2017-10-23 |
| Find all providers in zip 55113 | ||||
| Taxonomy Code | 3336H0001X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Home Infusion Therapy Pharmacy |
| Pharmacy-based, decentralized patient care organization with expertise in USP 797-compliant sterile drug compounding that provides care to patients with acute or chronic conditions generally pertaining to parenteral administration of drugs, biologics and nutritional formulae administered through catheters and/or needles in home and alternate sites. Extensive professional pharmacy services, care coordination, infusion nursing services, supplies and equipment are provided to optimize efficacy and compliance. |
| Notes: Source: National Home Infusion Association [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932266632 | Pediatric Home Respiratory Services LLC | Pharmacy | 2800 Cleveland Ave N, Roseville, MN 55113-1126 | 2007-01-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912060146 | Biorx LLC | Pharmacy | 8690 Eagle Creek Pkwy, Savage, MN 55378-1284 | 2006-12-19 |
| 1821048950 | Accredo Health Group Inc | Pharmacy | 2915 Waters Rd, Ste 109, Eagan, MN 55121-1562 | 2006-05-11 |
| 1689112898 | Park Nicollet Methodist Hospital | Pharmacy | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2017-02-08 |
| 1942663711 | Healtheast Care System | Pharmacy | 1700 University Ave W, Saint Paul, MN 55104 | 2016-03-30 |
| 1548595218 | Healtheast Care System | Pharmacy | 1700 University Ave W, 4th Floor, Saint Paul, MN 55104-3727 | 2009-10-13 |
| 1942424742 | Park Nicollet Methodist Hospital | Pharmacy | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2007-04-12 |
| 1962537118 | Fairview Pharmacy Services, LLC | Pharmacy | 711b Kasota Ave Se, Minneapolis, MN 55414 | 2007-02-21 |
| 1841332764 | Children's Health Care | Pharmacy | 2525 Chicago Avenue South, Minneapolis, MN 55404-4518 | 2007-02-14 |
| 1336180116 | Merwin Iv & Specialty Pharmacy, LLC | Pharmacy | 1811 Old Highway 8 Nw, Ste C, New Brighton, MN 55112-1828 | 2006-06-10 |
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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.