MODERN KETAMINE CLINIC
NPI 1386366532
Clinic/Center - Infusion Therapy in Maple Grove, MN
About Modern Ketamine Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MODERN KETAMINE CLINIC (NPI 1386366532) is a healthcare organization registered as an infusion therapy in Maple Grove, Minnesota and active in the NPI registry since September 2022. The organization lists Daniel Gregory Falvey, Md, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Modern Ketamine 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 Modern Ketamine 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.
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 Modern Ketamine Clinic's NPI number?
The NPI number for Modern Ketamine Clinic is 1386366532. It was assigned to this organization in the NPPES registry on September 14, 2022.
Where is Modern Ketamine Clinic located?
Modern Ketamine Clinic is located at 13792 Reimer Dr N, Maple Grove, MN 55311. The listed phone number is (763) 347-2100.
What is Modern Ketamine Clinic's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Infusion Therapy, with taxonomy code 261QI0500X.
Is Modern Ketamine Clinic enrolled in Medicare?
Yes. Modern Ketamine Clinic is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Modern Ketamine Clinic?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Emergency Medicine) reassigns their Medicare billing to Modern Ketamine Clinic. 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 Modern Ketamine Clinic was last updated on May 28, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.
# Modern Ketamine Clinic · NPI 1386366532
Infusion Therapy organization in Maple Grove, Minnesota. Organization record, active in the CMS NPPES registry since September 14, 2022.
## Identity
- **NPI:** 1386366532 (Entity type: Organization)
- **Enumerated:** September 14, 2022
- **Primary specialty:** Clinic/Center - Infusion Therapy · taxonomy 261QI0500X
- **Organization subpart:** No
- **Authorized official:** Daniel Falvey, MD
## Practice location
- **Address:** 13792 REIMER DR N, Maple Grove, MN 55311-2219
- **Phone:** (763) 347-2100 · **Fax:** (763) 333-7174
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Emergency Medicine) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 28, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1386366532) · Data from the CMS NPPES public registry.