Individual provider Active NPI

Patrick Juenemann, M.D.

  • Diagnostic Radiology Physician
  • Saint Paul, MN
National Provider Identifier
1295776573
Registry record updated Apr 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
30268 Issued in MN
Practice address
250 Thompson St
Saint Paul, MN 55102-2370
Phone
(651) 292-2000
Fax
(651) 292-2136
NPI assigned
Jun 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 30268 MN Primary

Addresses

Primary practice location

250 Thompson St
Saint Paul, MN 55102-2370

Mailing address

4801 W 81St St
Suite 108
Bloomington, MN 55437-1111
Phone (952) 837-9700

Other practice location 1

9055 Springbrook Dr NW
Coon Rapids, MN 55433-5841
Phone (763) 780-9155

Other practice location 2

4801 W 81st St
Suite 108
Bloomington, MN 55437-1111
Phone (952) 837-9700

Other identifiers 1

IdentifierTypeStateIssuer
375887700MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
30268MNMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Consulting Radiologists, LTD Diagnostic Radiology Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556236800000",
    "number": "1295776573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 W 81ST ST",
            "address_2": "SUITE 108",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554371111",
            "telephone_number": "952-837-9700",
            "fax_number": "952-837-9701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 THOMPSON ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551022370",
            "telephone_number": "651-292-2000",
            "fax_number": "651-292-2136"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9055 Springbrook Dr NW",
            "address_purpose": "LOCATION",
            "city": "Coon Rapids",
            "state": "MN",
            "postal_code": "554335841",
            "country_code": "US",
            "telephone_number": "763-780-9155",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4801 W 81st St",
            "address_2": "Suite 108",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "MN",
            "postal_code": "554371111",
            "country_code": "US",
            "telephone_number": "952-837-9700",
            "fax_number": "952-837-9701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JUENEMANN",
        "first_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2019-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "30268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "375887700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Apr 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.