Organization Active NPI

Synergy Family Physicians, P.a.

  • Family Medicine Physician
  • White Bear Lake, MN
National Provider Identifier
1548575434
Registry record updated Aug 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SYNERGY FAMILY PHYSICIANS, P.A.
Practice address
4422 White Bear Ave N
White Bear Lake, MN 55110-3475
Phone
(651) 287-8780
Fax
(651) 287-8786
NPI assigned
Aug 16, 2010
Last updated
Aug 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2010

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

Authorized official

Name
Jennifer A Carpenter, M.D.
Title
Owner / President
Phone
(651) 287-8780

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU

Addresses

Primary practice location

4422 White Bear Ave N
White Bear Lake, MN 55110-3475

Mailing address

4422 White Bear Ave N
White Bear Lake, MN 55110-3475
Phone (651) 287-8780

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110121000476 MN Part B Supplier - Clinic/Group Practice 2466631593 Receives reassigned benefits from 7 practitioners
Practice locations: White Bear Lake, MN

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
24D2012493Synergy Family Physicians4422 White Bear Avenue, White Bear Lake, MN 55110Provider-performed microscopySep 2, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1281916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281916800000",
    "number": "1548575434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4422 WHITE BEAR AVE N",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103475",
            "telephone_number": "651-287-8780",
            "fax_number": "651-287-8786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4422 WHITE BEAR AVE N",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103475",
            "telephone_number": "651-287-8780",
            "fax_number": "651-287-8786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYNERGY FAMILY PHYSICIANS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-16",
        "last_updated": "2010-08-16",
        "status": "A",
        "authorized_official_last_name": "CARPENTER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER / PRESIDENT",
        "authorized_official_telephone_number": "651-287-8780",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in White Bear Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.