Life Medical, P.a. - Medicare Primary Care in Saint Louis Park, MN

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Life Medical, P.a. is a medicare enrolled primary clinic (Clinic/center - Multi-specialty) in Saint Louis Park, Minnesota. The current practice location for Life Medical, P.a. is 4201 Excelsior Blvd, Saint Louis Park, Minnesota. For appointments, you can reach them via phone at (952) 933-1121. The mailing address for Life Medical, P.a. is 4201 Excelsior Blvd, Saint Louis Park, Minnesota and phone number is (952) 933-8900.

Life Medical, P.a. is licensed to practice in Minnesota (license number ). The clinic also participates in the medicare program and its NPI number is 1740222496. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (952) 933-1121.

Contact Information

Life Medical, P.a.
4201 Excelsior Blvd
Saint Louis Park
MN 55416-4728
(952) 933-1121
(952) 945-9536

Map and Direction


Primary Care Clinic Profile

Full NameLife Medical, P.a.
SpecialityClinic/Center
Location4201 Excelsior Blvd, Saint Louis Park, Minnesota
Authorized Official Name and PositionOlga V Sheveleva (FINANCIAL CONTROLLER)
Authorized Official Contact9529331121
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Life Medical, P.a.
4201 Excelsior Blvd
Saint Louis Park
MN 55416-4728

Ph: (952) 933-8900		Life Medical, P.a.
4201 Excelsior Blvd
Saint Louis Park
MN 55416-4728

Ph: (952) 933-1121

NPI Details:

NPI Number1740222496
Provider Enumeration Date06/10/2006
Last Update Date11/30/2022

Medicare PECOS Information:

Medicare PECOS PAC ID6204938350
Medicare Enrollment IDO20070221000166

Medical Identifiers

Medical identifiers for Life Medical, P.a. such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1740222496NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
261QM1300XClinic/center - Multi-specialty (Minnesota)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Life Medical, P.a. acts as a billing entity for following providers:
Provider NameLawrence W Biel
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1508818824
PECOS PAC ID: 6204810625
Enrollment ID: I20040615000207
Provider NameBettejane K Goldman
Provider TypePractitioner - Registered Dietitian Or Nutrition Professional
Provider IdentifiersNPI Number: 1528211836
PECOS PAC ID: 0042254427
Enrollment ID: I20050616000380
Provider NameRaisa Gringauz
Provider TypePractitioner - Physical Medicine And Rehabilitation
Provider IdentifiersNPI Number: 1396905212
PECOS PAC ID: 8224061742
Enrollment ID: I20050915000300
Provider NameScott D Wagner
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1982648051
PECOS PAC ID: 0244332062
Enrollment ID: I20070226000509
Provider NameJacob I Mirman
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1568404440
PECOS PAC ID: 9537263058
Enrollment ID: I20070322000334
Provider NameDavid J Freidson
Provider TypePractitioner - Chiropractic
Provider IdentifiersNPI Number: 1821169129
PECOS PAC ID: 2961584370
Enrollment ID: I20080124000189
Provider NameNina R Bacaner
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1578576021
PECOS PAC ID: 8628153889
Enrollment ID: I20080312000100
Provider NameConstantin Nicolaevich Starchook
Provider TypePractitioner - Pain Management
Provider IdentifiersNPI Number: 1942251822
PECOS PAC ID: 7810030673
Enrollment ID: I20100203000055
Provider NameJack Lm Mutnick
Provider TypePractitioner - Allergy/immunology
Provider IdentifiersNPI Number: 1487601316
PECOS PAC ID: 1658400866
Enrollment ID: I20100526001002
Provider NameCole Anthony Buchtel
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1811281645
PECOS PAC ID: 4688938244
Enrollment ID: I20180507001447
Provider NameSarah Anne Frid
Provider TypePractitioner - Chiropractic
Provider IdentifiersNPI Number: 1538766324
PECOS PAC ID: 9133539497
Enrollment ID: I20201028000857
Provider NameTaran John Barrett
Provider TypePractitioner - Chiropractic
Provider IdentifiersNPI Number: 1285205351
PECOS PAC ID: 7416353818
Enrollment ID: I20210910000318
Provider NameJenni Mezeritski
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1447973201
PECOS PAC ID: 0840663225
Enrollment ID: I20230317000116
Provider NameKer Xiong
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1548809890
PECOS PAC ID: 5597126292
Enrollment ID: I20230727002520
Provider NameMai Ko Xiong
Provider TypePractitioner - Clinical Social Worker
Provider IdentifiersNPI Number: 1033986534
PECOS PAC ID: 1850744665
Enrollment ID: I20240129001833
Provider NameAkhsa Simonovich
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1003599614
PECOS PAC ID: 0244675072
Enrollment ID: I20240301003056

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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.