ST. CROIX FAMILY MEDICAL CLINIC
NPI 1578680872
Family Medicine in Stillwater, MN

Q: What is Southside Community Health Services, Inc.'s specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since March 23, 2007

5640 MEMORIAL AVE N, SUITE B, STILLWATER, MN 55082(651) 430-1880(651) 430-1323 Get Directions Write a Review

NPPES record last updated: April 30, 2014. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About St. Croix Family Medical Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ST. CROIX FAMILY MEDICAL CLINIC (NPI 1578680872) is a healthcare organization registered as a family medicine in Stillwater, Minnesota and active in the NPI registry since March 2007. The organization lists William Henry Tendle, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1578680872

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameSOUTHSIDE COMMUNITY HEALTH SERVICES, INC.

Location Address5640 MEMORIAL AVE N, SUITE BStillwater, MN 55082-2166

Mailing Address4243 4th Ave SMinneapolis, MN 55409-2113 · (612) 822-9030 · Fax (612) 821-2818

Phone(651) 430-1880

Fax(651) 430-1323

Organization SubpartNo

Authorized OfficialWilliam Henry TendleExecutive Director · (612) 821-2800

Enumeration DateMarch 23, 2007

Last NPPES UpdateApril 30, 2014

✔ NPI 1578680872 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

5640 MEMORIAL AVE N, Stillwater, MN 55082

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Other Names 1

Other NameSt. Croix Family Medical Clinic

Other Identifiers 2

Medicaid943170500MN

Medicare PINC00626MN

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

St. Croix Family Medical 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 St. Croix Family Medical Clinic, which bills Medicare for the services this clinician delivers.

Clinician (1)

Victoria Valena, APRN, CNP

Nurse Practitioner

NPI 1851360671

7430 WENTWORTH AVE
Richfield, MN 55423

(612) 488-0040

✔ PECOS✔ Accepts Medicare24 mi

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 Southside Community Health Services, Inc.'s NPI number?

The NPI number for Southside Community Health Services, Inc. is 1578680872. It was assigned to this organization in the NPPES registry on March 23, 2007. The provider is also known as St. Croix Family Medical Clinic.

Where is Southside Community Health Services, Inc. located?

Southside Community Health Services, Inc. is located at 5640 Memorial Ave N Suite B, Stillwater, MN 55082. The listed phone number is (651) 430-1880.

What is Southside Community Health Services, Inc.'s specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Southside Community Health Services, Inc. enrolled in Medicare?

Yes. Southside Community Health Services, Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southside Community Health Services, Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Southside Community Health Services, 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.

When was this NPI record last updated?

The NPPES record for Southside Community Health Services, Inc. was last updated on April 30, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.