Individual provider Active NPI

Vedavathi Ramesh Bellamkonda-Athmaram

  • Pediatrics Physician
  • Plymouth, MN
National Provider Identifier
1477828515
Registry record updated Aug 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
58892 Issued in MN
Practice address
2855 Campus Dr
#350
Plymouth, MN 55441-2649
Phone
(763) 520-1200
Fax
(612) 874-2908
NPI assigned
Mar 21, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 58892 MN Primary

Addresses

Primary practice location

2855 Campus Dr
#350
Plymouth, MN 55441-2649

Mailing address

2855 Campus Dr
#350
Plymouth, MN 55441-2649
Phone (763) 520-1200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160127001046 MN Practitioner - Pediatric Medicine 4385947266 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
58892MNMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Clinic Network CurrentSince Dec 26, 2015 Accepting new patients
Children'S Clinic Network CurrentSince Dec 26, 2015 Accepting new patients
Metropolitan Pediatric Specialists, P.a. Past Accepting new patients

Locations

12720 Bass Lake Rd
Maple Grove, MN 55369
Phone (763) 278-0804

5901 Lincoln Dr
#2
Saint Louis Park, MN 55436
Phone (952) 992-5691

3910 Excelsior Blvd
St Louis Park, MN 55416
Phone (952) 562-8787

1547 Livingston Ave
West St Paul, MN 55118
Phone (651) 451-8050

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1332288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438819200000",
    "number": "1477828515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2855 CAMPUS DR",
            "address_2": "#350",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554412649",
            "telephone_number": "763-520-1200",
            "fax_number": "612-874-2908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 CAMPUS DR",
            "address_2": "#350",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554412649",
            "telephone_number": "763-520-1200",
            "fax_number": "612-874-2908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELLAMKONDA-ATHMARAM",
        "first_name": "VEDAVATHI",
        "middle_name": "RAMESH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-21",
        "last_updated": "2015-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "58892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

Verify at the official NPI Registry.