Active NPI
Juan-Ita Effiom, OTR
- Specialist
- Richfield, MN
National Provider Identifier
1528413150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 105137
- Practice address
- 7727 Portland Ave
Richfield, MN 55423-4320 - Phone
- (612) 861-2135
- NPI assigned
- May 2, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 105137 | MN | Primary |
Addresses
Primary practice location
7727 Portland Ave
Richfield, MN 55423-4320
Mailing address
7727 Portland Ave
Richfield, MN 55423-4320
Phone (612) 861-2135
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105137 | MN | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462233600000",
"number": "1528413150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7727 PORTLAND AVE",
"city": "RICHFIELD",
"state": "MN",
"postal_code": "554234320",
"telephone_number": "612-861-2135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7727 PORTLAND AVE",
"city": "RICHFIELD",
"state": "MN",
"postal_code": "554234320",
"telephone_number": "612-861-2135"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EFFIOM",
"first_name": "JUAN-ITA",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-02",
"last_updated": "2016-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MN",
"license": "105137",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richfield, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.