NPIMap

Organization Active NPI

Shriners Hospitals for Children

Doing business as Shriners Children's

  • Rehabilitation Clinic/Center
  • Woodbury, MN
National Provider Identifier
1285250977
Registry record updated Oct 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
SHRINERS HOSPITALS FOR CHILDREN
Doing business as
Shriners Children's
Practice address
215 Radio Dr Ste 100
Woodbury, MN 55125-5817
Phone
(612) 596-6100
NPI assigned
Jun 18, 2020
Last updated
Oct 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2021

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

Authorized official

Name
Jerry G. Gantt
Title
President
Phone
(813) 281-0300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Rehabilitation Clinic/Center 261QR0400X NU Primary

Addresses

Primary practice location

215 Radio Dr Ste 100
Woodbury, MN 55125-5817

Mailing address

PO Box 8500 Lockbox 7642
Philadelphia, PA 19178-1435
Phone (813) 281-0300

Other names 1

  • Shriners Children's Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140606000217 MN Part B Supplier - Clinic/Group Practice 9133031933 Receives reassigned benefits from 39 practitioners
4 other NPIs on this enrollment
Practice locations: Woodbury, MN

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Member organizations 26

Organizations listed as members of this organization in the National Provider Directory.

View all 26

Locations

2900 N Rocky Point Dr
Tampa, FL 33607
Phone (813) 281-7135

Ownership & related parties

All facility ownership & control disclosures 9

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Shriners Hospitals for ChildrenPhiladelphia, PA, CCN 393309 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 24, 1966
Jun 24, 1966
Shriners Hospitals for ChildrenPortland, OR, CCN 383300 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 15, 1966
Jan 15, 2015
Shriners Hospitals for ChildrenGalveston, TX, CCN 453311 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 20, 1966
Mar 20, 1966
Shriners Hospitals for ChildrenHonolulu, HI, CCN 123301 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2013
Oct 1, 2013
Shriners Hospitals for ChildrenSacramento, CA, CCN 053311 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Apr 15, 1997
Apr 15, 1997
Shriners Hospitals for ChildrenGreenville, SC, CCN 423300 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Aug 20, 2013
Jul 15, 2010
Shriners Children's OhioDayton, OH, CCN 363308 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 19, 1968
Feb 19, 1968
Shriners Hospitals for ChildrenChicago, IL, CCN 143302 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 1966
Jan 1, 1966
Shriners Hospitals for ChildrenSaint Louis, MO, CCN 263304 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 1966
Jan 1, 1966

Practitioners & affiliated clinicians

Practitioners 41

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 41

NPI Registry JSON

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

{
    "created_epoch": "1592438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635379200000",
    "number": "1285250977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8500 LOCKBOX 7642",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191781435",
            "telephone_number": "813-281-0300",
            "fax_number": "813-281-0943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 RADIO DR STE 100",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551255817",
            "telephone_number": "612-596-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHRINERS HOSPITALS FOR CHILDREN",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-18",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A",
        "authorized_official_last_name": "GANTT",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-281-0300"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shriners Children's",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shriners Children's",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodbury, MN

Sources for this page

Verify at the official NPI Registry.