Active NPI
Anna Petryk, MD
- Pediatric Endocrinology Physician
- Minneapolis, MN
National Provider Identifier
1295819498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Endocrinology Physician
- License
- 41703
- Practice address
- 516 Delaware Street SE
PWB Fourth Floor, Room 4-100
Minneapolis, MN 55455 - Phone
- (612) 626-6777
- NPI assigned
- Oct 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Endocrinology Physician | 2080P0205X | 41703 | MN | Primary |
Addresses
Primary practice location
516 Delaware Street SE
PWB Fourth Floor, Room 4-100
Minneapolis, MN 55455
Mailing address
420 Delaware Street
University of Minnesota Physicians
Minneapolis, MN 55455
Phone (612) 626-6777
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33-07044 | Other | MN | MEDICA CHOICE |
| 33-00009 | Other | MN | MEDICA PRIMARY |
| 0051935 | Medicaid | MT | |
| 1020148 | Other | MN | PREFERRED ONE |
| 844859 | Other | MN | ARAZ |
| 731022600 | Medicaid | MN | |
| HP28931 | Other | MN | HEALTH PARTNERS |
| 123733 | Other | MN | UCARE |
| 7777470 | Medicaid | SD | |
| 10387 | Medicaid | ND | |
| 20G50PE | Other | MN | BLUE CROSS BLUE SHIELD |
| 32593900 | Medicaid | WI |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295819498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 DELAWARE STREET",
"address_2": "UNIVERSITY OF MINNESOTA PHYSICIANS",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55455",
"telephone_number": "612-626-6777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 DELAWARE STREET SE",
"address_2": "PWB FOURTH FLOOR, ROOM 4-100",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55455",
"telephone_number": "612-626-6777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRYK",
"first_name": "ANNA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0205X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Endocrinology",
"state": "MN",
"license": "41703",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA CHOICE",
"identifier": "33-07044",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA PRIMARY",
"identifier": "33-00009",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0051935",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1020148",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARAZ",
"identifier": "844859",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "731022600",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP28931",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "123733",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7777470",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10387",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "20G50PE",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32593900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.