NPIMap

Organization Active NPI

Pathway Virtu-Health

  • Family Nurse Practitioner
  • Shoreview, MN
National Provider Identifier
1073134284
Registry record updated Jan 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
PATHWAY VIRTU-HEALTH
Practice address
4570 Churchill St Ste 140
Shoreview, MN 55126-2274
Phone
(612) 517-1293
Fax
(612) 349-2790
NPI assigned
Apr 28, 2020
Last updated
Jan 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2023

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

Authorized official

Name
Temitope Abiola Dawodu, DNP, FNP, PMHNP-BCNPI 1306296967
Title
Provider
Phone
(612) 517-1293

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Family Nurse Practitioner 363LF0000X NU Primary

Addresses

Primary practice location

4570 Churchill St Ste 140
Shoreview, MN 55126-2274

Mailing address

4570 Churchill St Ste 140
Shoreview, MN 55126-2274
Phone (612) 517-1293

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200521001372 MN Part B Supplier - Clinic/Group Practice 0446671739 Receives reassigned benefits from 1 practitioner
Practice locations: Shoreview, MN

National Provider Directory

National Provider Directory

Locations

4570 Churchill St
Ste 140
Shoreview, MN 55126
Phone (612) 361-9559

Practitioners & affiliated clinicians

Practitioners 75

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 75

NPI Registry JSON

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

{
    "created_epoch": "1588032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674172800000",
    "number": "1073134284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4570 CHURCHILL ST STE 140",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551262274",
            "telephone_number": "612-517-1293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4570 CHURCHILL ST STE 140",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551262274",
            "telephone_number": "612-517-1293",
            "fax_number": "612-349-2790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHWAY VIRTU-HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-28",
        "last_updated": "2023-01-20",
        "certification_date": "2023-01-20",
        "status": "A",
        "authorized_official_last_name": "DAWODU",
        "authorized_official_first_name": "TEMITOPE",
        "authorized_official_middle_name": "ABIOLA",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "612-517-1293",
        "authorized_official_credential": "DNP, FNP, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shoreview, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.