Active NPI
Jacqueline Fisher
- Pediatric Endocrinology Physician
- Minnetonka, MN
National Provider Identifier
1417441965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Endocrinology Physician
- License
- 76365
- Practice address
- 6060 Clearwater Dr
Minnetonka, MN 55343-9442 - Phone
- (651) 220-6064
- NPI assigned
- Jun 19, 2018
- Last updated
- May 30, 2024
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4301115527 | MI | |
| Pediatric Endocrinology Physician | 2080P0205X | 76365 | MN | Primary |
Addresses
Primary practice location
6060 Clearwater Dr
Minnetonka, MN 55343-9442
Mailing address
6060 Clearwater Dr
Minnetonka, MN 55343-9442
Phone (651) 220-6064
Other practice location 1
1500 E. Medical Center Drive
medical professional building D3238
Ann Arbor, MI 48109
Phone (734) 647-1774
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301115527 | MI | MD | Pediatrics Physician |
| 76365 | MN | MD | Pediatric Endocrinology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Childrens Health Care | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Childrens Hospitals and Clinics of Minnesota
- Children's Hospital
- Saint Paul, MN
- NPI 1629161781
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717027200000",
"number": "1417441965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6060 CLEARWATER DR",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553439442",
"telephone_number": "651-220-6064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6060 CLEARWATER DR",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553439442",
"telephone_number": "651-220-6064"
}
],
"practiceLocations": [
{
"address_1": "1500 E. Medical Center Drive",
"address_2": "medical professional building D3238",
"address_purpose": "LOCATION",
"city": "Ann Arbor",
"state": "MI",
"postal_code": "48109",
"country_code": "US",
"telephone_number": "734-647-1774",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FISHER",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-19",
"last_updated": "2024-05-30",
"certification_date": "2024-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "4301115527",
"primary": false
},
{
"code": "2080P0205X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Endocrinology",
"state": "MN",
"license": "76365",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.