Dermatology Center for Children & Young Adults PA

Primary specialty

Pediatric Dermatology PhysicianTaxonomy code 207NP0225X

Legal business name

DERMATOLOGY CENTER FOR CHILDREN & YOUNG ADULTS PA

Practice address

2795 Pilot Knob Rd
Suite 300
Eagan, MN 55121-1176

Phone

(651) 379-9999

Fax

(651) 379-9900

NPI assigned

Sep 16, 2006

Organization subpart

No

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

Authorized official

Name

Kenneth E Bloom, MD

Title

President

Phone

(651) 379-9999

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

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

• Sandra Mary Oehlke, C.P.N.P.

  • Pediatric Nurse Practitioner
  • Eagan, MN
  • NPI 1164442638
  NPD (past)

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1053417055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2795 PILOT KNOB RD",
            "address_2": "SUITE 300",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551211176",
            "telephone_number": "651-379-9999",
            "fax_number": "651-379-9900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2795 PILOT KNOB RD",
            "address_2": "SUITE 300",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551211176",
            "telephone_number": "651-379-9999",
            "fax_number": "651-379-9900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY CENTER FOR CHILDREN & YOUNG ADULTS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "BLOOM",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-379-9999",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207NP0225X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "2M741DE",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013837",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Dermatology Physician in Eagan, MN
• Providers in Eagan, MN by specialty
• Pediatric Dermatology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.