NPIMap

Organization Active NPI

Gillette Children's Specialty Healthcare

Doing business as Gillette Children's Professional Services

  • Multi-Specialty Clinic/Center
  • Saint Paul, MN
National Provider Identifier
1225119175
Registry record updated Dec 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Doing business as
Gillette Children's Professional Services
Practice address
200 East University Ave
St. Paul, MN 55101
Phone
(651) 291-2848
Fax
(651) 325-2250
NPI assigned
Oct 18, 2006
Last updated
Dec 13, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
GILLETTE CHILDREN'S SPECIALTY HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 13, 2019

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

Authorized official

Name
Patrick Nolan
Title
Cfo
Phone
(651) 312-3105

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

200 East University Ave
St. Paul, MN 55101

Mailing address

200 East University Ave
St. Paul, MN 55101
Phone (651) 291-2848

Other identifiers 4

IdentifierTypeStateIssuer
29006TEOtherMNBLUE CROSS & BLUE SHIELD
32809900MedicaidWI
0578435MedicaidIA
1225119175MedicaidMN

Other names 1

  • Gillette Children's Professional Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040503000485 MN Part B Supplier - Clinic/Group Practice 0547169211 Receives reassigned benefits from 310 practitioners
2 other NPIs on this enrollment
Practice locations: Willmar, MN; Saint Paul, MN; Saint Cloud, MN; Maple Grove, MN; Duluth, MN; Burnsville, MN; Bemidji, MN; Baxter, MN…

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Gillette Childrens Hosp

Practitioners & affiliated clinicians

Practitioners 314

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.

View all 314

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576195200000",
    "number": "1225119175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 EAST UNIVERSITY AVE",
            "city": "ST. PAUL",
            "state": "MN",
            "postal_code": "55101",
            "telephone_number": "651-291-2848",
            "fax_number": "651-325-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 EAST UNIVERSITY AVE",
            "city": "ST. PAUL",
            "state": "MN",
            "postal_code": "55101",
            "telephone_number": "651-291-2848",
            "fax_number": "651-325-2250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GILLETTE CHILDREN'S SPECIALTY HEALTHCARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GILLETTE CHILDREN'S SPECIALTY HEALTHCARE",
        "enumeration_date": "2006-10-18",
        "last_updated": "2019-12-13",
        "certification_date": "2019-12-13",
        "status": "A",
        "authorized_official_last_name": "NOLAN",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "651-312-3105"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "29006TE",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32809900",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0578435",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225119175",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gillette Children's Professional Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.