NPIMap

Organization Active NPI

Minimed Distribution Corp.

  • Durable Medical Equipment & Medical Supplies
  • Northridge, CA
National Provider Identifier
1356334577
Registry record updated Mar 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
101284 Issued in CA
Legal business name
MINIMED DISTRIBUTION CORP.
Practice address
18000 Devonshire St
Attn: Legal Dept.
Northridge, CA 91325-1219
Phone
(800) 933-3322
Fax
(818) 576-6228
NPI assigned
Aug 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2023

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

Authorized official

Name
Que Dallara
Title
President
Phone
(800) 646-4633

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 101284 CA Primary

Addresses

Primary practice location

18000 Devonshire St
Attn: Legal Dept.
Northridge, CA 91325-1219

Mailing address

18000 Devonshire St
Attn: Managed Markets
Northridge, CA 91325-1219
Phone (800) 646-4633

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930066352 CA DME Supplier - Medical Supply Company 7911028303 Practice locations: Northridge, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Minimed Distribution Corp.18000 Devonshire St, Northridge, CA 91325-1219(800) 646-4633 Blood Glucose Monitors/Supplies (Mail Order)|Insulin Infusion Pumps and/or Supplies Accepts assignmentParticipating since Jan 1, 2002

National Provider Directory

National Provider Directory
Tax ID family
Minimed Distribution Corp18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Locations

9850 NW 41st St
Ste 450
Doral, FL 33178

3555 Koger Blvd
Ste 200
Duluth, GA 30096

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679875200000",
    "number": "1356334577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18000 DEVONSHIRE ST",
            "address_2": "ATTN: MANAGED MARKETS",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913251219",
            "telephone_number": "800-646-4633",
            "fax_number": "818-739-4843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18000 DEVONSHIRE ST",
            "address_2": "ATTN: LEGAL DEPT.",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913251219",
            "telephone_number": "800-933-3322",
            "fax_number": "818-576-6228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINIMED DISTRIBUTION CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-23",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A",
        "authorized_official_last_name": "DALLARA",
        "authorized_official_first_name": "QUE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "800-646-4633"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "101284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northridge, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.