SUMMIT ADVANCE MOBILE WOUND CARE LLC
NPI 1316759566
Nurse Practitioner - Family in Maple Grove, MN
About Summit Advance Mobile Wound Care Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SUMMIT ADVANCE MOBILE WOUND CARE LLC (NPI 1316759566) is a healthcare organization registered as a family in Maple Grove, Minnesota and active in the NPI registry since January 2025. The organization lists Henry Momanyi, Nurse Practitioner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 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)
Summit Advance Mobile Wound Care Llc 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 Summit Advance Mobile Wound Care LLC, 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.
Frequently 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 Summit Advance Mobile Wound Care LLC's NPI number?
The NPI number for Summit Advance Mobile Wound Care LLC is 1316759566. It was assigned to this organization in the NPPES registry on January 24, 2025.
Where is Summit Advance Mobile Wound Care LLC located?
Summit Advance Mobile Wound Care LLC is located at 6773 Deerwood Ln N, Maple Grove, MN 55369. The listed phone number is (612) 598-8555.
What is Summit Advance Mobile Wound Care LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Summit Advance Mobile Wound Care LLC enrolled in Medicare?
Yes. Summit Advance Mobile Wound Care LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Summit Advance Mobile Wound Care LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Summit Advance Mobile Wound Care LLC. 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.
When was this NPI record last updated?
The NPPES record for Summit Advance Mobile Wound Care LLC was last updated on January 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months 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.
# Summit Advance Mobile Wound Care Llc · NPI 1316759566
Family organization in Maple Grove, Minnesota. Organization record, active in the CMS NPPES registry since January 24, 2025.
## Identity
- **NPI:** 1316759566 (Entity type: Organization)
- **Enumerated:** January 24, 2025
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **Organization subpart:** No
- **Authorized official:** Henry Momanyi, NURSE PRACTITIONER
## Practice location
- **Address:** 6773 DEERWOOD LN N, Maple Grove, MN 55369-5530
- **Phone:** (612) 598-8555
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 24, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1316759566) · Data from the CMS NPPES public registry.