Individual provider Active NPI

Thomas Reuter, MD

  • Pediatrics Physician
  • Minnetonka, MN
National Provider Identifier
1487304978
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
79369 Issued in MN
Practice address
17705 Hutchins Dr Ste 250
Minnetonka, MN 55345-4103
Phone
(952) 401-8300
Fax
(952) 401-8242
NPI assigned
Mar 27, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X 79369 MN Primary

Addresses

Primary practice location

17705 Hutchins Dr Ste 250
Minnetonka, MN 55345-4103

Mailing address

17705 Hutchins Dr Ste 250
Minnetonka, MN 55345-4103
Phone (952) 401-8300

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
I20220616000407 MN Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 0244619526

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
32912MNMDNephrology Physician
79369MNMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Lake Clinic, P.a. Pediatrics Past Accepting new patients

Organizations & group practices 1

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": "1648339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746576000000",
    "number": "1487304978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17705 HUTCHINS DR STE 250",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454103",
            "telephone_number": "952-401-8300",
            "fax_number": "952-401-8242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17705 HUTCHINS DR STE 250",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454103",
            "telephone_number": "952-401-8300",
            "fax_number": "952-401-8242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REUTER",
        "first_name": "THOMAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-27",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "79369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minnetonka, MN

Sources for this page

Verify at the official NPI Registry.