Active NPI
Stephanie Grady, PA & NP
- Family Medicine Physician
- Minneapolis, MN
National Provider Identifier
1003876814
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 9028
- Practice address
- 410 Church St SE
Minneapolis, MN 55455-0222 - Phone
- (612) 625-2612
- NPI assigned
- Mar 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 9028 | MN | Primary |
Addresses
Primary practice location
410 Church St SE
Minneapolis, MN 55455-0222
Mailing address
PO Box 43
Mr 10809
Minneapolis, MN 55440-0043
Phone (612) 262-4813
Other practice location 1
43500 Migizi Dr
Onamia, MN 56359-2241
Phone (320) 532-4163
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 326725300 | Medicaid | MN |
Other names 1
- Stephanie G Rodrique
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9028 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regents of the University of Minnesota | Past | Accepting new patients |
Interoperability endpoints
- d3@millelacs.directbygreenway.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Student Health Clinic/Center
- Minneapolis, MN
- NPI 1013137355
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1003876814",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 43",
"address_2": "MR 10809",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554400043",
"telephone_number": "612-262-4813",
"fax_number": "612-262-4194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 CHURCH ST SE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550222",
"telephone_number": "612-625-2612"
}
],
"practiceLocations": [
{
"address_1": "43500 Migizi Dr",
"address_purpose": "LOCATION",
"city": "Onamia",
"state": "MN",
"postal_code": "563592241",
"country_code": "US",
"telephone_number": "320-532-4163",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GRADY",
"first_name": "STEPHANIE",
"name_prefix": "Ms.",
"credential": "PA & NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-24",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "9028",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "326725300",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "STEPHANIE",
"last_name": "RODRIQUE",
"middle_name": "G",
"credential": "PA & NP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.