| Mcdonough Homes Clinic | |
|
1544 Timberlake Rd Saint Paul MN 55117-3946 | |
| (651) 558-2191 | |
| (651) 558-2205 |
| Full Name | Mcdonough Homes Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1544 Timberlake Rd, Saint Paul, Minnesota |
| Authorized Official Name and Position | Mavis Brehm (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6516027536 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mcdonough Homes Clinic 153 Cesar Chavez St Saint Paul MN 55107-2226 Ph: (651) 222-1816 | Mcdonough Homes Clinic 1544 Timberlake Rd Saint Paul MN 55117-3946 Ph: (651) 558-2191 |
| NPI Number | 1821149964 |
|---|---|
| Provider Enumeration Date | 01/16/2007 |
| Last Update Date | 06/10/2009 |
| Medicare PECOS PAC ID | 2062306434 |
|---|---|
| Medicare Enrollment ID | O20040209000647 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821149964 | NPI | - | NPPES |
| 072223500 | Medicaid | MN | |
| 173477 | Other | MN | UCARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Minnesota) | Primary |
| Provider Name | Michele Lynn Vanvranken |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255307252 PECOS PAC ID: 5698768117 Enrollment ID: I20040408000207 |
| Provider Name | Laurel M Gamm |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659473866 PECOS PAC ID: 2567458771 Enrollment ID: I20040422001422 |
| Provider Name | Timothy J Rumsey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124088315 PECOS PAC ID: 8022003268 Enrollment ID: I20040504000905 |
| Provider Name | Naomi N Duke |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366539496 PECOS PAC ID: 3577552538 Enrollment ID: I20040506001198 |
| Provider Name | Mark S Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093775686 PECOS PAC ID: 7810968880 Enrollment ID: I20040803001348 |
| Provider Name | Mary C Nesvig |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073572038 PECOS PAC ID: 2769454206 Enrollment ID: I20040806000338 |
| Provider Name | Susan A Benfield |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255300463 PECOS PAC ID: 2466428628 Enrollment ID: I20040908001414 |
| Provider Name | Kathleen A Culhane-pera |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922067735 PECOS PAC ID: 4183691348 Enrollment ID: I20040916000100 |
| Provider Name | Mary E Yee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679533574 PECOS PAC ID: 7315906559 Enrollment ID: I20041005000249 |
| Provider Name | Angela M Vargas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154381622 PECOS PAC ID: 1254393291 Enrollment ID: I20041101001140 |
| Provider Name | Lourdes R Borges Ruiz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104885391 PECOS PAC ID: 6901861632 Enrollment ID: I20041122001189 |
| Provider Name | Dennis G Bealka |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1336118520 PECOS PAC ID: 1759346356 Enrollment ID: I20041123000449 |
| Provider Name | Alison M Warford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467525527 PECOS PAC ID: 9032151311 Enrollment ID: I20050526000350 |
| Provider Name | Ilene R Moore |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659331445 PECOS PAC ID: 5991737454 Enrollment ID: I20050906000381 |
| Provider Name | Patricia J Longard |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1912969247 PECOS PAC ID: 4183632037 Enrollment ID: I20060404000208 |
| Provider Name | Tamara L Jackman |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1053371872 PECOS PAC ID: 3476550310 Enrollment ID: I20061107000055 |
| Provider Name | Jane K Peterson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598872806 PECOS PAC ID: 9436158466 Enrollment ID: I20061220000237 |
| Provider Name | Lisa L Paredes |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1023079423 PECOS PAC ID: 6002915691 Enrollment ID: I20070622000065 |
| Provider Name | Amy M Hanson |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1396707360 PECOS PAC ID: 2163521345 Enrollment ID: I20070629000063 |
| Provider Name | Cathy J Priess-perrott |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1275593063 PECOS PAC ID: 1052412509 Enrollment ID: I20070727000232 |
| Provider Name | Christine A Chitambar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922298132 PECOS PAC ID: 3779677307 Enrollment ID: I20070913000418 |
| Provider Name | Laura Pattison |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922295963 PECOS PAC ID: 6507956851 Enrollment ID: I20071226000442 |
| Provider Name | Jason M Como |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316137680 PECOS PAC ID: 1557441011 Enrollment ID: I20080109000586 |
| Provider Name | Elaine F Boehm |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1295990901 PECOS PAC ID: 6800961772 Enrollment ID: I20080813000089 |
| Provider Name | Carmen Hupf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467629519 PECOS PAC ID: 0648348110 Enrollment ID: I20081010000241 |
| Provider Name | Sonja M Batalden |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1255469276 PECOS PAC ID: 4587604426 Enrollment ID: I20090323000349 |
| Provider Name | Rebecca J Zadroga |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1023178746 PECOS PAC ID: 6709807803 Enrollment ID: I20090409000334 |
| Provider Name | Jessica G Pereira |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528266574 PECOS PAC ID: 3173664109 Enrollment ID: I20100112000684 |
| Provider Name | Stephen C Riendl |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1982670766 PECOS PAC ID: 8123920774 Enrollment ID: I20100317000588 |
| Provider Name | Bruce H Field |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023084076 PECOS PAC ID: 7517092042 Enrollment ID: I20100322000958 |
| Provider Name | Shelley Eiler Thron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326365693 PECOS PAC ID: 7416081997 Enrollment ID: I20100819000497 |
| Provider Name | Shandon R Halland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962735753 PECOS PAC ID: 7517150048 Enrollment ID: I20101018000157 |
| Provider Name | Victoria A Eddy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265404420 PECOS PAC ID: 0143419838 Enrollment ID: I20110111000976 |
| Provider Name | Stefan H Pomrenke |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881860567 PECOS PAC ID: 9537349097 Enrollment ID: I20110215001220 |
| Provider Name | Muaj C Lo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487644985 PECOS PAC ID: 8921051277 Enrollment ID: I20121022000596 |
| Provider Name | Ellen A Sevenich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871842328 PECOS PAC ID: 4183876592 Enrollment ID: I20121212000000 |
| Provider Name | Jessica Sanchez-alfaro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821278953 PECOS PAC ID: 7719124155 Enrollment ID: I20130502000455 |
| Provider Name | Maiyia L Yang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891067005 PECOS PAC ID: 5395961973 Enrollment ID: I20140717001985 |
| Provider Name | Joshua E Lackner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033499306 PECOS PAC ID: 6002038817 Enrollment ID: I20141111002408 |
| Provider Name | Tracy F Obrien |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1437402237 PECOS PAC ID: 8325359169 Enrollment ID: I20150619000480 |
| Provider Name | Kathleen H Donnelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790155638 PECOS PAC ID: 0547560005 Enrollment ID: I20151204002514 |
| Provider Name | Ijeoma N Ogbonnaya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558736843 PECOS PAC ID: 4082916648 Enrollment ID: I20160113002544 |
| Provider Name | Emily Katherine Rumsey |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1043670144 PECOS PAC ID: 3375822422 Enrollment ID: I20161114002139 |
| Provider Name | Shannon Whaley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780026419 PECOS PAC ID: 2264667385 Enrollment ID: I20170221001089 |
| Provider Name | Angelika Foley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003350695 PECOS PAC ID: 0547544314 Enrollment ID: I20170223001427 |
| Provider Name | Kara Jacobsen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437150356 PECOS PAC ID: 2365726494 Enrollment ID: I20170308002092 |
| Provider Name | Mary K English |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487951851 PECOS PAC ID: 4981966512 Enrollment ID: I20180320001556 |
| Provider Name | Sripathy Umapathi |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1669958195 PECOS PAC ID: 0244582849 Enrollment ID: I20181010000050 |
| Provider Name | Dannie Marie Paskewitz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740768878 PECOS PAC ID: 2163774787 Enrollment ID: I20181010000879 |
| Provider Name | Matthew John Buehler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992296016 PECOS PAC ID: 4385996529 Enrollment ID: I20181016002459 |
| Provider Name | Ashley Nicole Gyura |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821470162 PECOS PAC ID: 8921342882 Enrollment ID: I20181204000139 |
| Provider Name | Morgan Lm Weinert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689159360 PECOS PAC ID: 7012251994 Enrollment ID: I20181204000547 |
| Provider Name | Lauren K Graber |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982962544 PECOS PAC ID: 8224260146 Enrollment ID: I20190326001427 |
| Provider Name | Abagael Marie Snyder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013471242 PECOS PAC ID: 9537401518 Enrollment ID: I20190422002541 |
| Provider Name | Faisa Hassan Abdi-omar |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1467006700 PECOS PAC ID: 7911339866 Enrollment ID: I20191114000197 |
| Provider Name | Antionette Renee Estis |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1831745025 PECOS PAC ID: 5597193219 Enrollment ID: I20200311002798 |
| Provider Name | Cynthia Woods |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114305927 PECOS PAC ID: 1153614912 Enrollment ID: I20201230000835 |
| Provider Name | Gretchen M Alaniz |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1417691668 PECOS PAC ID: 0648658831 Enrollment ID: I20220531000945 |
| Provider Name | Renee Lynn Clark |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1003211251 PECOS PAC ID: 0042535585 Enrollment ID: I20240126001261 |
| Provider Name | Safiya Nur Ahmed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992300370 PECOS PAC ID: 1052756962 Enrollment ID: I20240301001841 |
| Provider Name | Haley Julia O'neill |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1285404228 PECOS PAC ID: 0749626596 Enrollment ID: I20240314002885 |
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