NPIMap

Organization Active NPI

Mendakota Pediatrics LTD

  • Pediatrics Physician
  • West St Paul, MN
National Provider Identifier
1497739320
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
31085 Issued in MN
Legal business name
MENDAKOTA PEDIATRICS LTD
Practice address
1880 Livingston Avenue
Suite 102
West St Paul, MN 55118
Phone
(651) 552-7999
Fax
(651) 552-0777
NPI assigned
Dec 5, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jennifer W Gobel, MDNPI 1932183167
Title
President
Phone
(651) 552-7999

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 31085 MN Primary

Addresses

Primary practice location

1880 Livingston Avenue
Suite 102
West St Paul, MN 55118

Mailing address

1880 Livingston Avenue
Suite 102
West St Paul, MN 55118
Phone (651) 552-7999

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D1025084Mendakota Pediatrics, LTD1880 Livingston Ave Ste 102, West Saint Paul, MN 55118AccreditationAug 24, 2027

National Provider Directory

National Provider Directory

Locations

1880 Livingston Ave
Ste 102
West St Paul, MN 55118
Phone (651) 552-7999

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497739320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1880 LIVINGSTON AVENUE",
            "address_2": "SUITE 102",
            "city": "WEST ST PAUL",
            "state": "MN",
            "postal_code": "55118",
            "telephone_number": "651-552-7999",
            "fax_number": "651-552-0777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1880 LIVINGSTON AVENUE",
            "address_2": "SUITE 102",
            "city": "WEST ST PAUL",
            "state": "MN",
            "postal_code": "55118",
            "telephone_number": "651-552-7999",
            "fax_number": "651-552-0777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDAKOTA PEDIATRICS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GOBEL",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-552-7999",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "31085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West St Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.