NPIMap

Organization Active NPI

Central Pediatrics, P.a.

  • Primary Care Clinic/Center
  • Woodbury, MN
National Provider Identifier
1396721387
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
CENTRAL PEDIATRICS, P.A.
Practice address
9680 Tamarack Rd Ste 100
Woodbury, MN 55125-2623
Phone
(651) 738-0470
Fax
(651) 731-5031
NPI assigned
Dec 21, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Ms. Kim Altendorf
Title
Administrator
Phone
(651) 731-5026

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X MN Primary

Addresses

Primary practice location

9680 Tamarack Rd Ste 100
Woodbury, MN 55125-2623

Mailing address

9680 Tamarack Rd Ste 100
Woodbury, MN 55125-2623
Phone (651) 738-0470

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0399893Central Pediatrics PA9680 Tamarack Road Suite 100, Woodbury, MN 55125AccreditationDec 22, 2027

National Provider Directory

National Provider Directory

Locations

2436 Cleveland Ave N
Roseville, MN 55113
Phone (651) 645-4693

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1396721387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9680 TAMARACK RD STE 100",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252623",
            "telephone_number": "651-738-0470",
            "fax_number": "651-731-5031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9680 TAMARACK RD STE 100",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252623",
            "telephone_number": "651-738-0470",
            "fax_number": "651-731-5031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL PEDIATRICS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-21",
        "last_updated": "2022-07-21",
        "certification_date": "2020-01-29",
        "status": "A",
        "authorized_official_last_name": "ALTENDORF",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "651-731-5026",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, 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.
  • 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.