Active NPI
Glen F Anderson, MD
- Pediatric Surgery Physician
- Minneapolis, MN
National Provider Identifier
1124089677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Surgery Physician
- License
- 26362
- Practice address
- 2530 Chicago Ave
#550
Minneapolis, MN 55404-4289 - Phone
- (612) 813-8000
- Fax
- (612) 813-8005
- NPI assigned
- Mar 31, 2006
- 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 |
|---|---|---|---|---|
| Pediatric Surgery Physician | 2086S0120X | 26362 | MN | Primary |
Addresses
Primary practice location
2530 Chicago Ave
#550
Minneapolis, MN 55404-4289
Mailing address
2530 Chicago Ave
#550
Minneapolis, MN 55404-4289
Phone (612) 813-8000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 932303100 | Medicaid | MN |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gillette Children'S Specialty Healthcare | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Multi-Specialty Clinic/Center
- Minnetonka, MN
- NPI 1598824880
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344384000000",
"number": "1124089677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2530 CHICAGO AVE",
"address_2": "#550",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554044289",
"telephone_number": "612-813-8000",
"fax_number": "612-813-8005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2530 CHICAGO AVE",
"address_2": "#550",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554044289",
"telephone_number": "612-813-8000",
"fax_number": "612-813-8005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "GLEN",
"middle_name": "F",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-31",
"last_updated": "2012-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0120X",
"taxonomy_group": "",
"desc": "Surgery, Pediatric Surgery",
"state": "MN",
"license": "26362",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "932303100",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.