NPIMap

Organization Active NPI

Capernaum Pediatric Therapy, Inc.

  • Home Health Agency
  • Edina, MN
National Provider Identifier
1336393297
Registry record updated Nov 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
CAPERNAUM PEDIATRIC THERAPY, INC.
Practice address
7250 France Ave S
Suite 305
Edina, MN 55435-4305
Phone
(952) 285-2840
NPI assigned
Nov 5, 2008
Last updated
Nov 5, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2008

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

Authorized official

Name
Bonna OlsonNPI 1689635047
Title
Owner/Adminstrator
Phone
(952) 285-2840

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

7250 France Ave S
Suite 305
Edina, MN 55435-4305

Mailing address

7250 France Ave S
Suite 305
Edina, MN 55435-4305

Medicare participation

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336393297. Details of each certification follow.

  • CCN 246569 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 246569

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CAPERNAUM PEDIATRIC THERAPY
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Sep 9, 1996
Last certification
Jun 8, 2016
Ownership / control type
Proprietary
Facility address
7250 France Ave S #305
Edina, MN 55435

National Provider Directory

National Provider Directory
Tax ID family
Capernaum Pediatric Therapy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225843200000",
    "number": "1336393297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7250 FRANCE AVE S",
            "address_2": "SUITE 305",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7250 FRANCE AVE S",
            "address_2": "SUITE 305",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354305",
            "telephone_number": "952-285-2840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPERNAUM PEDIATRIC THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-05",
        "last_updated": "2008-11-05",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "BONNA",
        "authorized_official_title_or_position": "OWNER/ADMINSTRATOR",
        "authorized_official_telephone_number": "952-285-2840"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.