NPIMap

Organization Active NPI

Children'S Clinic Network

  • Primary Care Clinic/Center
  • Maple Grove, MN
National Provider Identifier
1013278720
Registry record updated Oct 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CHILDREN'S CLINIC NETWORK
Practice address
12720 Bass Lake Rd
Maple Grove, MN 55369-6307
Phone
(763) 559-2861
Fax
(763) 559-1338
NPI assigned
May 30, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brenda Lu Alexander McCormick
Title
Sr. VP and Chief Financial Officer
Phone
(612) 813-6129

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

12720 Bass Lake Rd
Maple Grove, MN 55369-6307

Mailing address

5901 Lincoln Drive
CBC-2-Rev/Pe
Edina, MN 55436-1611
Phone (952) 992-5691

Other names 1

  • Partners in Pediatrics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130214000538 MN Part B Supplier - Clinic/Group Practice 5890949192 Receives reassigned benefits from 62 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West St Paul, MN; West Saint Paul, MN; Saint Louis Park, MN; Rogers, MN; Minnetonka, MN; Maple Grove, MN; Hugo, MN; Brooklyn Park, MN

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0400712Children'S Clinic Network12720 Bass Lake Road, Maple Grove, MN 55369AccreditationApr 17, 2028

National Provider Directory

National Provider Directory

Locations

3910 Excelsior Blvd
St Louis Park, MN 55416
Phone (952) 562-8787

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667174400000",
    "number": "1013278720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 LINCOLN DRIVE",
            "address_2": "CBC-2-REV/PE",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554361611",
            "telephone_number": "952-992-5691",
            "fax_number": "952-992-6917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12720 BASS LAKE RD",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553696307",
            "telephone_number": "763-559-2861",
            "fax_number": "763-559-1338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S CLINIC NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-30",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A",
        "authorized_official_last_name": "MCCORMICK",
        "authorized_official_first_name": "BRENDA LU",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "SR. VP AND CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "612-813-6129"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Partners in Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Partners in Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maple Grove, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.