NPIMap

Organization Active NPI

Gillette Children's Specialty Healthcare

Doing business as Gillette Children's Specialty Healthcare Pharmacy

  • Institutional Pharmacy
  • Saint Paul, MN
National Provider Identifier
1386758373
Registry record updated Sep 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Institutional PharmacyTaxonomy code 3336I0012X
License
262713 Issued in MN
Legal business name
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Doing business as
Gillette Childrens Specialty Healthcare
Gillette Children's Specialty Healthcare Pharmacy
Practice address
200 University Ave E
Saint Paul, MN 55101-2507
Phone
(651) 726-2890
Fax
(651) 726-2848
NPI assigned
Aug 18, 2006
Last updated
Sep 14, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2021

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

Authorized official

Name
Vanessa Hartzler
Title
Manager Payer Relations and Strateg
Phone
(651) 325-2209

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Institutional Pharmacy 3336I0012X 262713 MN Primary

Addresses

Primary practice location

200 University Ave E
Saint Paul, MN 55101-2507

Mailing address

200 University Ave E # 010614
Saint Paul, MN 55101-2507
Phone (651) 325-2209

Other identifiers 9

IdentifierTypeStateIssuer
1678053FMedicaidIA
21513MedicaidND
376978000MedicaidMN
1386758373MedicaidMT
33295600MedicaidWI
2049091OtherPK
100440690BMedicaidKS
8535290MedicaidSD
10025653700MedicaidNE

Other names 2

  • GILLETTE CHILDRENS SPECIALTY HEALTHCARE Doing business as
  • Gillette Children's Specialty Healthcare Pharmacy Doing business as

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
Gillette Childrens Specialty Health200 University Ave E, Saint Paul, MN 55101-2507(651) 325-2177 Wheelchairs (Standard Manual Related Accessories)|Wheelchairs (Standard Power Related Accessories)|Wheelchair Seating/Cushions|Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Cust… Accepts assignmentParticipating since Jan 1, 2009

National Provider Directory

National Provider Directory
Tax ID family
Gillette Childrens Hosp13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

200 University Ave E
#10614
Saint Paul, MN 55101

Practitioners & affiliated clinicians

Practitioners 30

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 30

NPI Registry JSON

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631577600000",
    "number": "1386758373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 UNIVERSITY AVE E # 010614",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012507",
            "telephone_number": "651-325-2209",
            "fax_number": "651-325-2221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 UNIVERSITY AVE E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012507",
            "telephone_number": "651-726-2890",
            "fax_number": "651-726-2848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GILLETTE CHILDREN'S SPECIALTY HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "HARTZLER",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_title_or_position": "MANAGER PAYER RELATIONS AND STRATEG",
        "authorized_official_telephone_number": "651-325-2209"
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "MN",
            "license": "262713",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1678053F",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21513",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "376978000",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386758373",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33295600",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2049091",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100440690B",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8535290",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025653700",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GILLETTE CHILDRENS SPECIALTY HEALTHCARE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gillette Children's Specialty Healthcare Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.