Individual provider Active NPI

Anna G. Rakovshik, MD

  • Pediatrics Physician
  • Plymouth, MN
National Provider Identifier
1194772319
Registry record updated Mar 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
56694 Issued in MN
Practice address
4155 County Road 101 N
Plymouth, MN 55446-2307
Phone
(952) 993-8900
NPI assigned
May 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 47934 WI
Pediatrics Physician 208000000X 56694 MN Primary

Addresses

Primary practice location

4155 County Road 101 N
Plymouth, MN 55446-2307

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
348482000MedicaidWI

Other names 1

  • Ms. Anna Golod Former name

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131017001069 MN Practitioner - Pediatric Medicine 2860404878 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
47934WIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Pediatrics CurrentSince Jul 27, 2013 Accepting new patients
Park Nicollet Clinic Pediatrics CurrentSince Jul 27, 2013 Accepting new patients

Locations

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

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

4155 County Road 101 N
Plymouth, MN 55446
Phone (952) 977-3000

3007 Harbor Ln N
Plymouth, MN 55447
Phone (612) 439-4650

Interoperability endpoints

  • Direct secure messaging: arakovshik153215@direct.healthpartners.com

Organizations & group practices 2

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": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615852800000",
    "number": "1194772319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4155 COUNTY ROAD 101 N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554462307",
            "telephone_number": "952-993-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAKOVSHIK",
        "first_name": "ANNA",
        "middle_name": "G.",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-31",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "47934",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "56694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "348482000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNA",
            "last_name": "GOLOD",
            "prefix": "MS.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Plymouth, MN

Sources for this page

Verify at the official NPI Registry.