Active NPI
Prema Padachira Jacob, ANP
- Adult Health Nurse Practitioner
- Minnetonka, MN
National Provider Identifier
1326076944
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 209005523
- Practice address
- 9900 Bren Rd E
Minnetonka, MN 55343-9664 - Phone
- (630) 870-9660
- NPI assigned
- Jun 30, 2006
- Last updated
- Jan 7, 2021
- 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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 209005523 | IL | Primary |
Addresses
Primary practice location
9900 Bren Rd E
Minnetonka, MN 55343-9664
Mailing address
9900 Bren Rd E
Minnetonka, MN 55343-9664
Phone (630) 870-9660
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 209005523 | Medicaid | IL |
Other names 1
- Ms. Prema Padachira Abraham
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
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alexian Brothers Medical Center | Past | Accepting new patients | |
| Alexian Brothers Medical Center | Past | Accepting new patients | |
| Midwest Heart Specialists, LTD | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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-
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- NPI 1477598589
-
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- Downers Grove, IL
- NPI 1417908765
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609977600000",
"number": "1326076944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9900 BREN RD E",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553439664",
"telephone_number": "630-870-9660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9900 BREN RD E",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553439664",
"telephone_number": "630-870-9660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "PREMA",
"middle_name": "PADACHIRA",
"name_prefix": "Mrs.",
"credential": "ANP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-30",
"last_updated": "2021-01-07",
"certification_date": "2021-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "IL",
"license": "209005523",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "209005523",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "PREMA",
"last_name": "ABRAHAM",
"middle_name": "PADACHIRA",
"prefix": "MS.",
"credential": "ANP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.