St Paul Internal Medicine

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

31392 Issued in MN

Legal business name

ST PAUL INTERNAL MEDICINE

Doing business as

St Peter Street Internal Medicine

Practice address

514 St Peter Street
Suite 250
St Paul, MN 55102

Phone

(651) 645-9600

Fax

(651) 645-9605

NPI assigned

Oct 3, 2006

Last updated

Jul 18, 2008By 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

Elisabeth A Slattery, MD

Title

Doctor/Owner

Phone

(651) 645-9600

Specialties & licenses 2

Addresses

Other identifiers 5

Other names 1

• St Peter Street Internal Medicine Doing business as

Practitioners 2

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.

• Sophia Hyang Kim, MD

  • Internal Medicine Physician
  • Saint Paul, MN
  • NPI 1386733129
  NPD (past)
• Teresa Anne Sanford, DNP, CNP

  • Family Nurse Practitioner
  • Waukesha, WI
  • NPI 1356320055
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216339200000",
    "number": "1174617146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 SHINGLE CREEK PKWY",
            "address_2": "SUITE 300",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302128",
            "telephone_number": "763-561-5986",
            "fax_number": "763-561-6280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 ST PETER STREET",
            "address_2": "SUITE 250",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "55102",
            "telephone_number": "651-645-9600",
            "fax_number": "651-645-9605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST PAUL INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2008-07-18",
        "status": "A",
        "authorized_official_last_name": "SLATTERY",
        "authorized_official_first_name": "ELISABETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DOCTOR/OWNER",
        "authorized_official_telephone_number": "651-645-9600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "31392",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "0409583",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "938088400",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "948448000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "10N38ST",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DF1694",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Peter Street Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• St Paul Como Community Unit
• St Paul Dental Center LLC
• St Paul Eye Clinic PA
• St Paul Eye Clinic PA
• St Paul Family Dentistry
• St Paul Oral Surgery and Dental Implants LLC (St. Paul Oral Surgery)
• St Paul Pharmacy LLC
• St Paul Plastic Surgery LTD
• St Paul Primary Care (Arcade Medical Clinic)
• St Paul Ramsey County Dept of Public HLTH

• Internal Medicine Physician in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Internal Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.