NPIMap

Individual provider Active NPI

Heather R Cichanowski, MD

  • Sports Medicine (Family Medicine) Physician
  • Saint Paul, MN
National Provider Identifier
1295701548
Registry record updated May 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
44664 Issued in MN
Practice address
435 Phalen Blvd
Mail Stop 51103H
Saint Paul, MN 55130-5302
Phone
(651) 254-8300
Fax
(651) 254-8379
NPI assigned
Feb 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 46784020 WI
Sports Medicine (Family Medicine) Physician 207QS0010X 44664 MN Primary

Addresses

Primary practice location

435 Phalen Blvd
Mail Stop 51103H
Saint Paul, MN 55130-5302

Mailing address

435 Phalen Blvd
Mail Stop 51103H
Saint Paul, MN 55130-5302
Phone (651) 254-8300

Other identifiers 1

IdentifierTypeStateIssuer
177272400MedicaidMN

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
I20050323001028 MN Practitioner - Family PracticePractitioner - Orthopedic SurgeryPractitioner - Sports Medicine 0244286110 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
University of Minnesota Medical School, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tria Orthopaedic Center LLCGroup PAC ID 3173570561, 504 clinicians

Practice addresses (Care Compare)

155 Radio Dr
Woodbury, MN 55125-2619
Phone (952) 831-8742

8100 Northland Dr
Bloomington, MN 55431-4800
Phone (952) 831-8742

Hospital & facility affiliations

  • Regions Hospital Hospital, Saint Paul, MN, CCN 240106

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
46784020WIMDFamily Medicine Physician
44664MNMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tria Orthopaedic Center LLC CurrentSince Mar 1, 2015 Accepting new patients
Group Health, Inc. Current Accepting new patients
Tria Orthopaedic Center LLC CurrentSince Mar 1, 2015 Accepting new patients
Group Health, Inc. CurrentSince Sep 1, 2005 Accepting new patients

Locations

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

8100 Northland Dr
Minneapolis, MN 55431
Phone (952) 831-1626

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

435 Phalen Blvd
Stop 51103H
Saint Paul, MN 55130
Phone (651) 254-8300

155 Radio Dr
Woodbury, MN 55125
Phone (952) 883-6212

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": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337644800000",
    "number": "1295701548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 PHALEN BLVD",
            "address_2": "MAIL STOP 51103H",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551305302",
            "telephone_number": "651-254-8300",
            "fax_number": "651-254-8379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 PHALEN BLVD",
            "address_2": "MAIL STOP 51103H",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551305302",
            "telephone_number": "651-254-8300",
            "fax_number": "651-254-8379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CICHANOWSKI",
        "first_name": "HEATHER",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-27",
        "last_updated": "2012-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "46784020",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MN",
            "license": "44664",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "177272400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.