Individual provider Active NPI

Cheryl Romana, DDS

  • Dentist
  • Minneapolis, MN
National Provider Identifier
1053537522
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D11501 Issued in MN
Practice address
4243 4TH Ave S
Minneapolis, MN 55409-2113
Phone
(612) 822-9030
Fax
(612) 821-2818
NPI assigned
Apr 17, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D11501 MN Primary

Addresses

Primary practice location

4243 4TH Ave S
Minneapolis, MN 55409-2113

Mailing address

4243 4TH Ave S
Minneapolis, MN 55409-2113
Phone (612) 822-9030

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150109001044 MN Practitioner - Oral Surgery 0648594143

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Southside Community Health Services, Inc. CurrentSince Jan 1, 2014 Accepting new patients
Southside Community Health Services, Inc. Current Accepting new patients
Southside Community Health Services, Inc. CurrentSince Jan 1, 2014 Accepting new patients

Locations

4243 4th Ave S
Minneapolis, MN 55409
Phone (612) 821-2003

324 E 35th St
Minneapolis, MN 55408
Phone (612) 827-7181

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053537522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4243 4TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554092113",
            "telephone_number": "612-822-9030",
            "fax_number": "612-821-2818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4243 4TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554092113",
            "telephone_number": "612-822-9030",
            "fax_number": "612-821-2818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROMANA",
        "first_name": "CHERYL",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D11501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.