Individual provider Active NPI

Carrie M Reynoso, RD, LD

  • Registered Dietitian
  • Maple Grove, MN
National Provider Identifier
1295061026
Registry record updated Dec 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
2851 Issued in MN
Practice address
14500 99TH Ave N
Maple Grove, MN 55369-4730
Phone
(763) 898-1000
NPI assigned
Oct 29, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 2851 MN Primary

Addresses

Primary practice location

14500 99TH Ave N
Maple Grove, MN 55369-4730

Mailing address

14500 99TH Ave N # Thaven
Maple Grove, MN 55369-4730
Phone (763) 898-1000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100119000649 MN Practitioner - Registered Dietitian Or Nutrition Professional 0446392187 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
92.35 of 100Reported as group
Quality
91.74
Promoting interoperability
100
Improvement activities
40
Cost
77.13

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Touchstone Mental Health Current Accepting new patients
Touchstone Mental Health CurrentSince May 27, 2014 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Express Care CurrentSince Jan 9, 2021 Accepting new patients
Fairview Health Services CurrentSince Nov 21, 2018 Accepting new patients
Fairview Express Care CurrentSince Jan 9, 2021 Accepting new patients
Fairview Health Services Dietitian, Registered Current Accepting new patients
Fairview Clinics CurrentSince Jan 9, 2021 Accepting new patients
Fairview Clinics CurrentSince Jan 9, 2021 Accepting new patients
Fairview Clinics Current Accepting new patients
Family Support Services Inc. Past Accepting new patients
Fairview Clinics Past Accepting new patients
Nystrom & Associates, LTD PastSince Jan 16, 2012 Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

14500 99th Ave N
Maple Grove, MN 55369
Phone (763) 898-1000

14500 99th Ave N
Ste 100
Maple Grove, MN 55369
Phone (763) 898-1000

400 Stinson Blvd
Fl 2
Minneapolis, MN 55413
Phone (612) 672-2203

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

2312 Snelling Ave
Minneapolis, MN 55404
Phone (612) 314-1020

6320 Wedgwood Rd N
Osseo, MN 55311
Phone (763) 268-0400

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

Organizations & group practices 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1256774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544486400000",
    "number": "1295061026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14500 99TH AVE N # THAVEN",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694730",
            "telephone_number": "763-898-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14500 99TH AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694730",
            "telephone_number": "763-898-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOSO",
        "first_name": "CARRIE",
        "middle_name": "M",
        "credential": "RD, LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-29",
        "last_updated": "2018-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MN",
            "license": "2851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.