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Individual provider Active NPI

Tenner Johan Guillaume, MD

  • Orthopaedic Surgery of the Spine Physician
  • Saint Paul, MN
National Provider Identifier
1215133129
Registry record updated Dec 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
53014 Issued in MN
Practice address
200 University Ave E
Gillette Children'S Specialty Healthcare
Saint Paul, MN 55101-2507
Phone
(651) 578-5197
Fax
(651) 312-3188
NPI assigned
Jun 26, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X A99345 CA
Orthopaedic Surgery of the Spine Physician 207XS0117X 53014 MN Primary

Addresses

Primary practice location

200 University Ave E
Gillette Children'S Specialty Healthcare
Saint Paul, MN 55101-2507

Mailing address

200 University Ave E
Gillette Children'S Specialty Healthcare
Saint Paul, MN 55101-2507
Phone (651) 578-5197

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101207001369 MN Practitioner - Orthopedic Surgery 6800083536 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Minnesota Medical School, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gillette Childrens Specialty HealthcareGroup PAC ID 0547169211, 99 clinicians

Practice addresses (Care Compare)

200 University Ave E
Saint Paul, MN 55101-2507
Phone (651) 291-2848

435 Phalen Blvd
Saint Paul, MN 55130-5302
Phone (651) 636-9443

Hospital & facility affiliations

  • Gillette Childrens Specialty Hospital Hospital, Saint Paul, MN, CCN 243300

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A99345CAMDOrthopaedic Surgery Physician
53014MNMDOrthopaedic Surgery of the Spine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gillette Children'S Specialty Healthcare CurrentSince Sep 1, 2011 Accepting new patients
Gillette Children'S Specialty Healthcare CurrentSince Sep 1, 2011 Accepting new patients
Gillette Children'S Specialty Healthcare Past Accepting new patients
Gillette Children'S Specialty Healthcare Past Accepting new patients

Locations

305 E Nicollet Blvd
Ste 200
Burnsville, MN 55337
Phone (952) 223-3400

9550 Upland Ln N
Ste 220
Maple Grove, MN 55369
Phone (612) 902-8595

200 University Ave E
Saint Paul, MN 55101
Phone (651) 291-2848

200 University Ave E
Rm 10609
Saint Paul, MN 55101

Organizations & group practices 4

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322697600000",
    "number": "1215133129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 UNIVERSITY AVE E",
            "address_2": "GILLETTE CHILDREN'S SPECIALTY HEALTHCARE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012507",
            "telephone_number": "651-578-5197",
            "fax_number": "651-312-3188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 UNIVERSITY AVE E",
            "address_2": "GILLETTE CHILDREN'S SPECIALTY HEALTHCARE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012507",
            "telephone_number": "651-578-5197",
            "fax_number": "651-312-3188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUILLAUME",
        "first_name": "TENNER",
        "middle_name": "JOHAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-26",
        "last_updated": "2011-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A99345",
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "MN",
            "license": "53014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.