SERENITYMIND CLINIC LLC – Psychiatric/Mental Health Nurse Practitioner, NPI 1811888407

SERENITYMIND CLINIC LLC is a healthcare provider. based in Cottage grove, Minnesota. specializing in Psychiatric/Mental Health Nurse Practitioner. The NPI Number for SERENITYMIND CLINIC LLC is 1811888407

Main info

Organization
Name
SERENITYMIND CLINIC LLC
NPI
1811888407
Phone
(651) 237-3319
Address
6818 91ST ST S
Authorized Official
FUNSHO KING OWNER OF ENTITY
Enumeration Date
11 July 2025
Last Update Date
11 July 2025
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience15
Completeness85
Years active:0State licenses:0Digital endpointsOther names

Provider Addresses for SERENITYMIND CLINIC LLC

  • 6818 91ST ST S

    COTTAGE GROVE, MN 550164184

    Phone: (651) 237-3319

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-08-11

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20250811000912OClinic/Group PracticeMNTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55016)

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Reviews

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Frequently asked questions

How do payers reference SERENITYMIND CLINIC LLC?
For SERENITYMIND CLINIC LLC, use NPI 1811888407 as the unique 10-digit identifier.
Active or inactive — what applies to SERENITYMIND CLINIC LLC?
You should see SERENITYMIND CLINIC LLC as active in CMS-hosted NPPES data.
What expertise is attributed to SERENITYMIND CLINIC LLC?
SERENITYMIND CLINIC LLC's specialty line reads Psychiatric/Mental Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Where in Minnesota is SERENITYMIND CLINIC LLC registered?
Use Cottage Grove, Minnesota as the headline location for SERENITYMIND CLINIC LLC here.
Can I trust this NPI listing for SERENITYMIND CLINIC LLC?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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