Individual provider Active NPI

Chandrawatie Khemraj, APRN

  • Nurse Practitioner
  • Andover, MN
National Provider Identifier
1164964334
Registry record updated Feb 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4884 Issued in MN
Practice address
15245 Bluebird St NW
Andover, MN 55304-3538
Phone
(763) 587-4688
Fax
(763) 587-4662
NPI assigned
Nov 5, 2016
Last updated
Feb 8, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4884 MN Primary

Addresses

Primary practice location

15245 Bluebird St NW
Andover, MN 55304-3538

Mailing address

8170 33Rd Ave S
Ms 21110Q
Bloomington, MN 55425-4516

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161220001846 MN Practitioner - Nurse Practitioner 6103107784 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

15245 Bluebird NWST
Andover, MN 55304-3554
Phone (763) 712-6000

2621 Greenhaven Rd
Anoka, MN 55303-1776
Phone (952) 853-8800

530 3Rd St NW
Elk River, MN 55330-1445
Phone (763) 712-6000

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System Current Accepting new patients
St. Francis Regional Medical Center CurrentSince Oct 1, 2018 Accepting new patients
Allina Health System CurrentSince Oct 1, 2018 Accepting new patients
Group Health, Inc. CurrentSince Feb 7, 2022 Accepting new patients
Group Health, Inc. Current Accepting new patients
Group Health, Inc. CurrentSince Feb 7, 2022 Accepting new patients
Allina Health System CurrentSince Oct 1, 2018 Accepting new patients

Locations

15245 Bluebird St NW
Anoka, MN 55304
Phone (763) 587-4600

2621 Greenhaven Rd
Anoka, MN 55303
Phone (763) 587-4400

530 3rd St NW
Elk River, MN 55330
Phone (763) 587-4800

265 Creek Ln S
Jordan, MN 55352
Phone (952) 428-1200

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

3930 Northwoods Dr
Saint Paul, MN 55112
Phone (651) 490-6775

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1478304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644278400000",
    "number": "1164964334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "address_2": "MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15245 BLUEBIRD ST NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553043538",
            "telephone_number": "763-587-4688",
            "fax_number": "763-587-4662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHEMRAJ",
        "first_name": "CHANDRAWATIE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-05",
        "last_updated": "2022-02-08",
        "certification_date": "2022-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "4884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Andover, MN

Sources for this page

Verify at the official NPI Registry.