Eden Prairie Clinic, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

EDEN PRAIRIE CLINIC, PA

Practice address

9358 Ensign Ave S
Suite C
Bloomington, MN 55438-1472

Phone

(952) 944-6989

NPI assigned

Oct 27, 2010

Organization subpart

No

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

Authorized official

Name

Radha Krishna Kumar, M.D.

Title

Owner

Phone

(952) 944-6989

Specialties & licenses 4

Addresses

Locations

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

{
    "created_epoch": "1288137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288224000000",
    "number": "1437459211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9358 ENSIGN AVE S",
            "address_2": "SUITE C",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554381472",
            "telephone_number": "952-944-6989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9358 ENSIGN AVE S",
            "address_2": "SUITE C",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554381472",
            "telephone_number": "952-944-6989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN PRAIRIE CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-27",
        "last_updated": "2010-10-28",
        "status": "A",
        "authorized_official_last_name": "KRISHNA KUMAR",
        "authorized_official_first_name": "RADHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-944-6989",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QA0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Eckert
• Sarah Julianna Ecklund, MS, OTR
• Carrie Eckstam, D.O.
• Themistocles Peter Economou, M.D.
• Karly Edelen
• Edenwood Health LLC
• Anthony Victor Edholm, MD
• Edina Physical Medicine Consultants, PA
• Isabella Grace Edling
• Amanda Edmonson

• Family Medicine Physician in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.