Active NPI
Gretchen M Rierson, MD
- Pediatrics Physician
- Minneapolis, MN
National Provider Identifier
1306847314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 45102
- Practice address
- 3955 Parklawn Ave
Minneapolis, MN 55435-5655 - Phone
- (952) 831-4454
- NPI assigned
- Aug 2, 2005
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 45102 | MN | Primary |
Addresses
Primary practice location
3955 Parklawn Ave
Minneapolis, MN 55435-5655
Mailing address
3955 Parklawn Ave
Minneapolis, MN 55435-5655
Phone (952) 831-4454
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 609883500 | Medicaid | MN |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45102 | MN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southdale Pediatric Associates, LTD | Past | Accepting new patients | |
| Fairview Health Services | Past | Accepting new patients |
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/1846cf9e-8006-4277-b72f-3cbbe8a8f5ca/
Organizations & group practices 2
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.
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- Edina, MN
- NPI 1699752915
-
- Multi-Specialty Clinic/Center
- Edina, MN
- NPI 1245305895
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1306847314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3955 PARKLAWN AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554355655",
"telephone_number": "952-831-4454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3955 PARKLAWN AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554355655",
"telephone_number": "952-831-4454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIERSON",
"first_name": "GRETCHEN",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-02",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "45102",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "609883500",
"state": "MN"
}
],
"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 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.