Active NPI
Anna Heronimus, RD, LD
- Registered Dietitian
- Eagan, MN
National Provider Identifier
1144699000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 3983
- Practice address
- 1500 Central Park Commons Dr
Eagan, MN 55121-8702 - Phone
- (361) 405-3664
- NPI assigned
- Sep 22, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 0515 | SD | |
| Registered Dietitian | 133V00000X | 3983 | MN | Primary |
Addresses
Primary practice location
1500 Central Park Commons Dr
Eagan, MN 55121-8702
Mailing address
1500 Central Park Commons Dr
Eagan, MN 55121-8702
Phone (651) 405-3660
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144699000 | Medicaid | SD |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0515 | SD | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourish, Inc. | Dietitian, Registered | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551052800000",
"number": "1144699000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 CENTRAL PARK COMMONS DR",
"city": "EAGAN",
"state": "MN",
"postal_code": "551218702",
"telephone_number": "651-405-3660",
"fax_number": "651-405-3691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 CENTRAL PARK COMMONS DR",
"city": "EAGAN",
"state": "MN",
"postal_code": "551218702",
"telephone_number": "361-405-3664"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERONIMUS",
"first_name": "ANNA",
"credential": "RD, LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-22",
"last_updated": "2019-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "SD",
"license": "0515",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "3983",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1144699000",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eagan, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.