Pediatric Orthotic and Prosthetic Services - Midwest, LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - MIDWEST, LLC

Practice address

215 Radio Dr Ste 100
Woodbury, MN 55125-5817

Phone

(612) 593-6205

Fax

(612) 335-5396

NPI assigned

Sep 2, 2014

Organization subpart

Yes

Parent organization

PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - MIDWEST, LLCAs reported in NPPES

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

Authorized official

Name

Mr. Jeffrey J Bruce, CPO

Title

Manager

Phone

(612) 596-6205

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Pediatric Orthotic and Prosthetic Services - Midwest, LLC

  • Prosthetic/Orthotic Supplier
  • Chicago, IL
  • NPI 1760835938

  9436463288

  Same PAC ID
• Pediatric Orthotic and Prosthetic Services-Midwest, LLC

  • Prosthetic/Orthotic Supplier
  • Lexington, KY
  • NPI 1578937876

  9436463288

  Same PAC ID

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

Medicare medical equipment & supply locations

Tax ID family

Pediatric Orthotic and Prosthetic Services-Midwest LLC3 organizations share this tax ID, including this one

Part of

Pediatric Orthotic and Prosthetic Services-Midwest LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Pediatric Orthotic and Prosthetic Services - Midwest, LLC

  • Prosthetic/Orthotic Supplier
  • Chicago, IL
  • NPI 1760835938
  NPD tax ID
• Pediatric Orthotic and Prosthetic Services-Midwest, LLC

  • Prosthetic/Orthotic Supplier
  • Lexington, KY
  • NPI 1578937876
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Shriners Hospitals for Children

  • Children's Hospital
  • Honolulu, HI
  • NPI 1316065360

  Member Of

  NPD member

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

{
    "created_epoch": "1409616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745366400000",
    "number": "1154721785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 947109",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303947109",
            "telephone_number": "813-367-2876",
            "fax_number": "813-518-7659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 RADIO DR STE 100",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551255817",
            "telephone_number": "612-593-6205",
            "fax_number": "612-335-5396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - MIDWEST, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - MIDWEST, LLC",
        "enumeration_date": "2014-09-02",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A",
        "authorized_official_last_name": "BRUCE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "612-596-6205",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• PDG, P.a.
• PDG, PA
• Katerina Pearson
• James Pederson
• Maria T Pederson, CNM
• Lori Peiffer, L.P.
• Ashley Lynn Peine, PA-C
• Jeffrey Craig Pellersels, DPM
• Penticoff Community Counseling, Inc.
• Renee Marie Penticoff, PSY.D.

• Prosthetic/Orthotic Supplier in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Prosthetic/Orthotic Supplier in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2025; 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.