NPIMap

Organization Active NPI

Minnesota Oncology Hematology, PA

  • Gynecologic Oncology Physician
  • Coon Rapids, MN
National Provider Identifier
1447409834
Registry record updated Sep 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
Legal business name
MINNESOTA ONCOLOGY HEMATOLOGY, PA
Practice address
3960 Coon Rapids Blvd NW
Suite 101
Coon Rapids, MN 55433-2569
Phone
(612) 863-8585
NPI assigned
Sep 10, 2008
Last updated
Sep 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2008

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

Authorized official

Name
Thomas P. Flynn, M.D.
Title
President
Phone
(612) 863-3961

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecologic Oncology Physician 207VX0201X NU Primary

Addresses

Primary practice location

3960 Coon Rapids Blvd NW
Suite 101
Coon Rapids, MN 55433-2569

Mailing address

2550 University Ave W
Suite 110N
Saint Paul, MN 55114-1052
Phone (651) 602-5335

Other identifiers 2

IdentifierTypeStateIssuer
896027500MedicaidMN
8T400MIOtherMNBLUE CROSS BLUE SHIELD OF MINNESOTA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031106000626 MN Part B Supplier - Clinic/Group Practice 6709799752 Receives reassigned benefits from 160 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Maplewood, MN; Minneapolis, MN; Plymouth, MN; Saint Paul, MN; Waconia, MN; Woodbury, MN; Edina, MN; Fridley, MN…

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1221004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221004800000",
    "number": "1447409834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 UNIVERSITY AVE W",
            "address_2": "SUITE 110N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141052",
            "telephone_number": "651-602-5335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3960 COON RAPIDS BLVD NW",
            "address_2": "SUITE 101",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332569",
            "telephone_number": "612-863-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA ONCOLOGY HEMATOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-10",
        "last_updated": "2008-09-10",
        "status": "A",
        "authorized_official_last_name": "FLYNN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-863-3961",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "896027500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF MINNESOTA",
            "identifier": "8T400MI",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coon Rapids, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.