VILLAGE COMMUNITY CLINIC
NPI 1164175220
Clinic/Center - Primary Care in Saint Paul, MN
About Village Community Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
VILLAGE COMMUNITY CLINIC (NPI 1164175220) is a healthcare organization registered as a primary care in Saint Paul, Minnesota and active in the NPI registry since January 2022. The organization holds a CLIA Waiver certificate valid through December 29, 2026 and lists Ramon Nola, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Village Community Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Village Community Clinic, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 24D2258685
Village Community Clinic · Saint Paul, MNFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Village Community Clinic Inc's NPI number?
The NPI number for Village Community Clinic Inc is 1164175220. It was assigned to this organization in the NPPES registry on January 29, 2022. The provider is doing business as Village Community Clinic.
Where is Village Community Clinic Inc located?
Village Community Clinic Inc is located at 1001 Johnson Pkwy Ste A1, Saint Paul, MN 55106. The listed phone number is (651) 321-8856.
What is Village Community Clinic Inc's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Village Community Clinic Inc enrolled in Medicare?
Yes. Village Community Clinic Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Village Community Clinic Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Village Community Clinic Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Village Community Clinic Inc hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 24D2258685) is associated with this NPI, valid through December 29, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Village Community Clinic Inc was last updated on May 22, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Village Community Clinic · NPI 1164175220
Primary Care organization in Saint Paul, Minnesota. Organization record, active in the CMS NPPES registry since January 29, 2022.
## Identity
- **NPI:** 1164175220 (Entity type: Organization)
- **Enumerated:** January 29, 2022
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Legal business name:** Village Community Clinic Inc
- **Organization subpart:** No
- **Authorized official:** Ramon Nola, OWNER
## Practice location
- **Address:** 1001 JOHNSON PKWY STE A1, Saint Paul, MN 55106-3655
- **Phone:** (651) 321-8856
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 22, 2024
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1164175220) · Data from the CMS NPPES public registry.