NPIMap

Organization Active NPI

Gillette Children's Specialty Healthcare

  • Customized Equipment (DME)
  • Mankato, MN
National Provider Identifier
1295145902
Registry record updated Dec 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
Legal business name
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Practice address
1421 Premier Dr
Suite 100
Mankato, MN 56001-6076
Phone
(507) 207-2700
NPI assigned
May 2, 2014
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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Durable Medical Equipment & Medical Supplies 332B00000X
Customized Equipment (DME) 332BC3200X Primary
Prosthetic/Orthotic Supplier 335E00000X

Addresses

Primary practice location

1421 Premier Dr
Suite 100
Mankato, MN 56001-6076

Mailing address

200 University Ave E
Saint Paul, MN 55101-2507
Phone (651) 325-2177

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060505000897 MN Part A Provider - Hospital 0547169211 8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mankato, MN; St Paul, MN; Minnetonka, MN; Maple Grove, MN; Duluth, MN; Burnsville, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295145902. Details of each certification follow.

Hospital certification: CCN 243300

Legal name
GILLETTE CHILDRENS SPECIALTY HEALTHCARE
Certification status
Active
Provider type (POS)
Hospital – Children’s
Participating since
Apr 5, 1984
Last certification
Jun 30, 1988
Beds
60
Ownership / control type
Hospital district or authority
Most recent change of ownership
Jan 3, 1989 (2 total)
Organization structure
OtherNon-profit
Enrollment address
200 University Ave E
St Paul, MN 55101-2507
Main/Primary Hospital Location
Hospital subgroups
Children’s

Other NPIs on the same Medicare enrollment 6

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Gillette Childrens Specialty HospitalCCN 243300 · All quality measures
Type
Childrens
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Part of
Gillette Child Prof SVC

Locations

1421 Premier Dr
Ste 100
Mankato, MN 56001
Phone (507) 207-2700

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Patrick Nolan Individual Corporate OfficerCfo Jul 1, 2019 50%
Charissa Debow Individual W-2 Managing Employee Nov 1, 2017
Barbara Joers Individual Corporate Officer Oct 1, 2013

Practitioners & affiliated clinicians

Affiliated clinicians 74

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 74

NPI Registry JSON

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

{
    "created_epoch": "1398988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576195200000",
    "number": "1295145902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 UNIVERSITY AVE E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012507",
            "telephone_number": "651-325-2177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 PREMIER DR",
            "address_2": "SUITE 100",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560016076",
            "telephone_number": "507-207-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GILLETTE CHILDREN'S SPECIALTY HEALTHCARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GILLETTE CHILDREN'S SPECIALTY HEALTHCARE",
        "enumeration_date": "2014-05-02",
        "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": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mankato, MN

Sources for this page

Verify at the official NPI Registry.