Active NPI
Stephanie M Walters, MD
- Family Medicine Physician
- Minneapolis, MN
National Provider Identifier
1396843900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 46898
- Practice address
- 1020 West Broadway
Ump Broadway Family Medicine
Minneapolis, MN 55411 - Phone
- (612) 302-8200
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 46898 | MN | Primary |
Addresses
Primary practice location
1020 West Broadway
Ump Broadway Family Medicine
Minneapolis, MN 55411
Mailing address
420 Delaware Street SE
MMC 292 University of Minnesota Physicians
Minneapolis, MN 55455
Phone (612) 302-8200
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 608R5WA | Other | MN | BLUE CROSS BLUE SHIELD |
| 66-08077 | Other | MN | MEDICA HEALTH PLANS |
| 611210 | Other | FAIRVIEW |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46898 | MN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1396843900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 DELAWARE STREET SE",
"address_2": "MMC 292 UNIVERSITY OF MINNESOTA PHYSICIANS",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55455",
"telephone_number": "612-302-8200",
"fax_number": "612-302-8275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1020 WEST BROADWAY",
"address_2": "UMP BROADWAY FAMILY MEDICINE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55411",
"telephone_number": "612-302-8200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTERS",
"first_name": "STEPHANIE",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "46898",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "608R5WA",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA HEALTH PLANS",
"identifier": "66-08077",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FAIRVIEW",
"identifier": "611210",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.