Individual provider Active NPI

Diane Mae Jerome Barry, DC

  • Chiropractor
  • Saint Paul, MN
National Provider Identifier
1396841540
Registry record updated Mar 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3422 Issued in MN
Practice address
1526 Grand Ave
Saint Paul, MN 55105-2227
Phone
(651) 690-9366
Fax
(651) 690-4736
NPI assigned
Sep 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3422 MN Primary

Addresses

Primary practice location

1526 Grand Ave
Saint Paul, MN 55105-2227

Mailing address

12450 Upper Heather Ave N
Hugo, MN 55038-8310
Phone (651) 429-4047

Other identifiers 5

IdentifierTypeStateIssuer
231957OtherMNCHIROCARE
44-42579OtherMNMEDICA
53971700OtherMNMEDICAL ASSISTANCE
0140OtherMNHEA;TH SERVICE MANAGEMENT
5C183JEOtherMNB:UE CROSS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060224000026 MN Practitioner - Chiropractic 3476579905 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Complete Chiropractic Health Services PAGroup PAC ID 6305866799, 2 clinicians

Practice addresses (Care Compare)

1526 Grand Ave
Saint Paul, MN 55105-2227
Phone (651) 690-9366

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3422MNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Complete Chiropractic Health Services, P.a. Chiropractor CurrentSince Sep 1, 1996 Accepting new patients

Locations

1526 Grand Ave
Saint Paul, MN 55105
Phone (612) 690-9366

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551830400000",
    "number": "1396841540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12450 UPPER HEATHER AVE N",
            "city": "HUGO",
            "state": "MN",
            "postal_code": "550388310",
            "telephone_number": "651-429-4047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1526 GRAND AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551052227",
            "telephone_number": "651-690-9366",
            "fax_number": "651-690-4736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARRY",
        "first_name": "DIANE",
        "middle_name": "MAE JEROME",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-15",
        "last_updated": "2019-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROCARE",
            "identifier": "231957",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "44-42579",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL ASSISTANCE",
            "identifier": "53971700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEA;TH SERVICE MANAGEMENT",
            "identifier": "0140",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "B:UE CROSS",
            "identifier": "5C183JE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Mar 6, 2019; 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.