Pediatric Surgical Associates LTD

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

Legal business name

PEDIATRIC SURGICAL ASSOCIATES LTD

Practice address

2530 Chicago Ave
Suite 550
Minneapolis, MN 55404-4289

Phone

(612) 813-8000

Fax

(612) 813-8005

NPI assigned

Apr 10, 2006

Last updated

Apr 8, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Paul Louiselle

Title

Executive Director

Phone

(612) 813-8006

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 52

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.

• Paul Richard Bowlin, MD

  • Urology Physician
  • Minneapolis, MN
  • NPI 1063637577
  Medicare reassignment NPD
• Alonso Carrasco Jr., MD

  • Pediatric Urology Physician
  • Minneapolis, MN
  • NPI 1710299706
  Medicare reassignment NPD
• Bethany Jayne Farr, MD, MPH

  • Pediatric Surgery Physician
  • Minneapolis, MN
  • NPI 1679991269
  Medicare reassignment NPD
• James E Fisher, M.D.

  • Pediatric Surgery Physician
  • Minneapolis, MN
  • NPI 1134327901
  Medicare reassignment NPD
• Brianna Marie Gloe, APRN, CPNP

  • Pediatric Nurse Practitioner
  • Minneapolis, MN
  • NPI 1881207462
  Medicare reassignment NPD
• Kelly Glynn, CPNP

  • Pediatric Nurse Practitioner
  • Minneapolis, MN
  • NPI 1104550680
  Medicare reassignment NPD
• Anna Havelka, C.P.N.P.

  • Pediatric Nurse Practitioner
  • Apple Valley, MN
  • NPI 1508936329
  Medicare reassignment NPD
• Amy H Hou, MD

  • Pediatric Urology Physician
  • Edina, MN
  • NPI 1508903857
  Medicare reassignment NPD
• Joel C Hutcheson, MD

  • Pediatric Urology Physician
  • Minneapolis, MN
  • NPI 1548221088
  Medicare reassignment NPD
• Susan Catherine Johnson

  • Family Nurse Practitioner
  • Minneapolis, MN
  • NPI 1821750753
  Medicare reassignment NPD
• Nathaniel S Kreykes, M.D.

  • Pediatrics Physician
  • Minneapolis, MN
  • NPI 1609818061

  Pediatric Surgery

  Medicare reassignment NPD
• Joseph B Lillegard, MD

  • Pediatric Surgery Physician
  • Minneapolis, MN
  • NPI 1346453644
  Medicare reassignment NPD

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775606400000",
    "number": "1093778292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4530 W 77TH ST",
            "address_2": "SUITE 205",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554355006",
            "telephone_number": "952-835-9442",
            "fax_number": "952-835-9443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 CHICAGO AVE",
            "address_2": "SUITE 550",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044289",
            "telephone_number": "612-813-8000",
            "fax_number": "612-813-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SURGICAL ASSOCIATES LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2026-04-08",
        "certification_date": "2026-04-08",
        "status": "A",
        "authorized_official_last_name": "LOUISELLE",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "612-813-8006",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "360710100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paris Pederson, LADC
• Suzanne K Pederson, M.S., L.P.
• Valerie Pederson, MS, LPCC
• Pediatric ENT Associates
• Pediatric Radiology, P.a.
• Pediatric Urology Associates, P.a.
• Peek Pca
• Syed Murfad Peer, M.D
• Abbas H Peera, M.D.
• Sophie Peery, MD

• Pediatric Surgery Physician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Pediatric Surgery Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2026; 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.