NPIMap

Organization Active NPI

Childrens Health Care Services Inc

  • Radiology Clinic/Center
  • Minnetonka, MN
National Provider Identifier
1528167491
Registry record updated Oct 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
License
331022 Issued in MN
Legal business name
CHILDRENS HEALTH CARE SERVICES INC
Practice address
6050 Clearwater Drive
Childrens Mtka Independent Diagnostic Testing Facility
Minnetonka, MN 55343
Phone
(952) 930-8600
Fax
(952) 930-8650
NPI assigned
Sep 21, 2006
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
Brenda Lu Alexander McCormick
Title
Sr. VP and Chief Financial Officer
Phone
(612) 813-6129

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X 331022 MN Primary

Addresses

Primary practice location

6050 Clearwater Drive
Childrens Mtka Independent Diagnostic Testing Facility
Minnetonka, MN 55343

Mailing address

5901 Lincoln Dr
CBC-2-Rev/Pe
Edina, MN 55436-1611
Phone (952) 992-5691

Other identifiers 1

IdentifierTypeStateIssuer
847979800MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100327000232 MN Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 2961391123 Practice locations: Minnetonka, MN

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667174400000",
    "number": "1528167491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 LINCOLN DR",
            "address_2": "CBC-2-REV/PE",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554361611",
            "telephone_number": "952-992-5691",
            "fax_number": "952-992-6917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6050 CLEARWATER DRIVE",
            "address_2": "CHILDRENS MTKA INDEPENDENT DIAGNOSTIC TESTING FACILITY",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "55343",
            "telephone_number": "952-930-8600",
            "fax_number": "952-930-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDRENS HEALTH CARE SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A",
        "authorized_official_last_name": "MCCORMICK",
        "authorized_official_first_name": "BRENDA LU",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "SR. VP AND CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "612-813-6129"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "MN",
            "license": "331022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "847979800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minnetonka, 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.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.