Active NPI
Pattaraphongpan Chaiyamart
- General Practice Registered Nurse
- Saint Paul, MN
National Provider Identifier
1043073133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Registered Nurse
- License
- 2489704
- Practice address
- 1048 Central Ave W
Saint Paul, MN 55104-4728 - Phone
- (612) 239-8235
- NPI assigned
- Feb 1, 2024
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | 2489704 | MN | Primary |
Addresses
Primary practice location
1048 Central Ave W
Saint Paul, MN 55104-4728
Mailing address
1048 Central Ave W
Saint Paul, MN 55104-4728
Phone (612) 239-8235
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2489704 | MN | MD | General Practice Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706832000000",
"number": "1043073133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1048 CENTRAL AVE W",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551044728",
"telephone_number": "612-239-8235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1048 CENTRAL AVE W",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551044728",
"telephone_number": "612-239-8235"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAIYAMART",
"first_name": "PATTARAPHONGPAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-02-01",
"last_updated": "2024-02-02",
"certification_date": "2024-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "163WG0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, General Practice",
"state": "MN",
"license": "2489704",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.