NPIMap

Organization Active NPI

Children's Health Care

Doing business as Northeast Pediatric Clinic

  • Primary Care Clinic/Center
  • Vadnais Heights, MN
National Provider Identifier
1477869311
Registry record updated Oct 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
347125 Issued in MN
Legal business name
CHILDREN'S HEALTH CARE
Doing business as
Northeast Pediatric Clinic
Practice address
4520 Centerville Rd
Vadnais Heights, MN 55127-3602
Phone
(651) 426-1141
NPI assigned
Aug 30, 2010
Last updated
Oct 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2022

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

Authorized official

Name
Jerry L Massmann
Title
Cfo
Phone
(612) 813-6113

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 347125 MN Primary

Addresses

Primary practice location

4520 Centerville Rd
Vadnais Heights, MN 55127-3602

Mailing address

2910 Centre Pointe Dr
Roseville, MN 55113-1182
Phone (651) 855-2109

Other names 1

  • Northeast Pediatric Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Childrens Health Care28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

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

View all 27

Locations

2910 Centre Pointe Dr
Saint Paul, MN 55113
Phone (651) 633-1155

NPI Registry JSON

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

{
    "created_epoch": "1283126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667174400000",
    "number": "1477869311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2910 CENTRE POINTE DR",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131182",
            "telephone_number": "651-855-2109",
            "fax_number": "651-855-2310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4520 CENTERVILLE RD",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551273602",
            "telephone_number": "651-426-1141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-30",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A",
        "authorized_official_last_name": "MASSMANN",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "612-813-6113"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MN",
            "license": "347125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Pediatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northeast Pediatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vadnais Heights, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; 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.