NPIMap

Organization Active NPI

Pediatric and Young Adult Medicine, PA

  • Primary Care Clinic/Center
  • Lake Elmo, MN
National Provider Identifier
1457593550
Registry record updated Dec 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
154 Issued in MN
Legal business name
PEDIATRIC AND YOUNG ADULT MEDICINE, PA
Practice address
8650 Hudson Blvd N
Suite 125
Lake Elmo, MN 55042-9747
Phone
(651) 256-6706
Fax
(651) 256-6707
NPI assigned
Apr 3, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2016

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

Authorized official

Name
Ms. Terri M Joseph
Title
Clinic Administrator
Phone
(651) 256-6706

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 154 MN Primary

Addresses

Primary practice location

8650 Hudson Blvd N
Suite 125
Lake Elmo, MN 55042-9747

Mailing address

1804 7TH St W
Suite 200
Saint Paul, MN 55116-2300
Phone (651) 256-6706

Other identifiers 10

IdentifierTypeStateIssuer
1104806165MedicaidMN
1245210095MedicaidMN
1245210210MedicaidMN
1861558835MedicaidMN
1083694046MedicaidMN
1477870921MedicaidMN
1386991339MedicaidMN
1881057065MedicaidMN
1912987900MedicaidMN
1497735419MedicaidMN

National Provider Directory

National Provider Directory
Tax ID family
Pediatric and Young Adult Medicine PA5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8650 Hudson Blvd N
Ste 125
Lake Elmo, MN 55042
Phone (651) 256-6706

NPI Registry JSON

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

{
    "created_epoch": "1238716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481068800000",
    "number": "1457593550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 7TH ST W",
            "address_2": "SUITE 200",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551162300",
            "telephone_number": "651-256-6706",
            "fax_number": "651-256-6707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8650 HUDSON BLVD N",
            "address_2": "SUITE 125",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "550429747",
            "telephone_number": "651-256-6706",
            "fax_number": "651-256-6707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC AND YOUNG ADULT MEDICINE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-03",
        "last_updated": "2016-12-07",
        "status": "A",
        "authorized_official_last_name": "JOSEPH",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "651-256-6706",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MN",
            "license": "154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104806165",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245210095",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245210210",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861558835",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083694046",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477870921",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386991339",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881057065",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912987900",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497735419",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Elmo, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2016; 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.