GATEWAY FAMILY HEALTH CLINIC, LTD. — NPI 1790772259 (Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center in SANDSTONE, MN)

CMS-1500 Box 24J / 33a • NPI

1790772259

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

261QR1300X (CMS B4[14])

Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center

Box 32 Service Location & ZIP+4

707 LUNDORFF DR STE 1, SANDSTONE, MN, 55072-5099

✓ 9-Digit EDI 837 ZIP+4 (55072-5099)

Practice Phone & Referral Fax

(320) 245-2250

Fax: (320) 245-2555

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1790772259 (GATEWAY FAMILY HEALTH CLINIC, LTD.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1790772259` (NPI-2 Organization / Facility)
Provider / Legal Name	GATEWAY FAMILY HEALTH CLINIC, LTD.
Plain-English Specialty	Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center NUCC Code: `261QR1300X` (Clinic/Center, Rural Health)
Certifying / Licensing Body	Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Practice Location Address	707 LUNDORFF DR STE 1, SANDSTONE, MN, 55072-5099
Practice Telephone / Fax	Tel: (320) 245-2250 \| Fax: (320) 245-2555
Administrative Mailing Address	4570 CTY HWY 61, MOOSE LAKE, MN, 55767-9401
Enumeration & Last Sync	Enumerated: 2005-09-30 \| CMS Record Updated: 2025-05-13
Authorized Official	ERIC NIELSEN (Administrator)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

707 LUNDORFF DR STE 1, SANDSTONE, MN, 55072-5099

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Plain-English Taxonomy & CMS Crosswalk (261QR1300X)

What Does Taxonomy Code 261QR1300X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 261QR1300X translates to:
"Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center"

CMS-1500 Medicare Specialty Crosswalk: CMS Code B4[14] (Rural Health Clinic)
Certifying / Accrediting Authority: Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Clinical Scope: Same-day outpatient consultations, urgent walk-in medical care, vaccinations, and day-case diagnostic procedures.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (GATEWAY FAMILY HEALTH CLINIC, LTD.)

Typical CPT / Diagnostic Procedures:

Walk-In Urgent Care Evaluation, Point-of-Care Testing & X-Ray
Same-Day Ambulatory Endoscopy, Cataract & Minor Surgical Procedures

Common Therapeutic Classes:

Outpatient Oral Antimicrobials, Analgesics, Nebulizers & Vaccines

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`106H00000X` — Marriage & Family Therapist Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Marriage and Family Therapist	State: N/A \| License: `Verified` \| Primary: Secondary
`111N00000X` — Chiropractor Plain English: Licensed & Credentialed Chiropractic Providers — Chiropractor	State: N/A \| License: `Verified` \| Primary: Secondary
`207Q00000X` — Family Medicine Plain English: Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor)	State: N/A \| License: `Verified` \| Primary: Secondary
`207R00000X` — Internal Medicine Plain English: Board-Certified Internist (Adult Diagnostic & Chronic Disease Physician)	State: N/A \| License: `Verified` \| Primary: Secondary
`208000000X` — Pediatrics Plain English: Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)	State: N/A \| License: `Verified` \| Primary: Secondary
`208D00000X` — General Practice Plain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice	State: N/A \| License: `Verified` \| Primary: Secondary
`363A00000X` — Physician Assistant Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant	State: N/A \| License: `Verified` \| Primary: Secondary
`363LF0000X` — Nurse Practitioner, Family Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family	State: N/A \| License: `Verified` \| Primary: Secondary
`367500000X` — Nurse Anesthetist, Certified Registered Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Anesthetist, Certified Registered	State: N/A \| License: `Verified` \| Primary: Secondary
`261QR1300X` — Clinic/Center, Rural Health Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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GATEWAY FAMILY HEALTH CLINIC, LTD. (NPI #1790772259)