Active NPI
Tracy Mindiola, RD
- Registered Dietitian
- Maple Grove, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 4379
- Practice address
- 12488 74TH Ave N
Maple Grove, MN 55369-5285 - Phone
- (763) 267-2015
- NPI assigned
- Jul 8, 2022
- Last updated
- Sep 12, 2023
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 4379 | MN | Primary |
Addresses
Primary practice location
12488 74TH Ave N
Maple Grove, MN 55369-5285
Mailing address
12488 74TH Ave N
Maple Grove, MN 55369-5285
Phone (763) 267-2015
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN, TX
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Famelia, Inc. | Dietitian, Registered | Current | Accepting new patients |
| Nourish, Inc. | Dietitian, Registered | Current | Accepting new patients |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
| Keepcare LLC | Dietitian, Registered | Past | Accepting new patients |
| Marjorie Nolan Cohn LLC | Dietitian, Registered | Past | Accepting new patients |
Locations
2208 University Blvd
Ste 102
Birmingham, AL 35233
Phone (205) 259-6710
1390 Market St
Ste 200
San Francisco, CA 94102
Phone (415) 864-4482
121 Washington Ave N
Fl 2
Minneapolis, MN 55401
Phone (302) 386-3653
317 E Capitol St
Ste 200
Jackson, MS 39201
Phone (317) 510-0758
500 Westover Dr
Sanford, NC 27330
Phone (478) 766-4000
3724 Jefferson St
Ste 104
Austin, TX 78731
Phone (512) 399-9039
5900 Balcones Dr
Ste 17502
Austin, TX 78731
125 College St
Ste 3
Burlington, VT 05401
Phone (802) 316-8288
Organizations & group practices 6
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.
-
- Registered Dietitian
- Maple Grove, MN
- NPI 1003544602
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1657238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694476800000",
"number": "1457084154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12488 74TH AVE N",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553695285",
"telephone_number": "763-267-2015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12488 74TH AVE N",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553695285",
"telephone_number": "763-267-2015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINDIOLA",
"first_name": "TRACY",
"name_prefix": "Mrs.",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-08",
"last_updated": "2023-09-12",
"certification_date": "2023-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "4379",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maple Grove, MN
- Camelia Miller
- Rachel Dawn Miller, PA-C
- Robert John Miller, LMFT
- Natasha Marie Mills
- Julie Ann Milnler
- Minnesota Bone and Joint Specialists, LTD
- Minnesota Counseling and Couples Center LLC
- Minnesota Dental Professionals, P.C. (Arbor Lakes Dental)
- Minnesota Dental Professionals, P.C.
- Minnesota Diagnostic Imaging Partners, LLC (Maple Grove Imaging Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; 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.