Individual provider Active NPI

Peter Benjamin Scal, MD

  • Pediatrics Physician
  • Minneapolis, MN
National Provider Identifier
1619077484
Registry record updated Sep 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
40605 Issued in MN
Practice address
2512 S 7TH St
Minneapolis, MN 55454-1404
Phone
(612) 365-6777
NPI assigned
Sep 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 40605 MN Primary

Addresses

Primary practice location

2512 S 7TH St
Minneapolis, MN 55454-1404

Mailing address

720 Washington Ave SE Ste 300
Minneapolis, MN 55414-2904

Other identifiers 14

IdentifierTypeStateIssuer
136416OtherMNFAIRVIEW
7777470MedicaidSD
1025762OtherMNPREFERRED ONE
0060411MedicaidMT
10387MedicaidND
1163348OtherMNARAZ
HP31785OtherMNHEALTH PARTNERS
12-00978OtherMNMEDICA CHOICE
12-09026OtherMNMEDICA PRIMARY
151276OtherMNUCARE
764415900MedicaidMN
0535047MedicaidIA
025A6SCOtherMNBLUE CROSS BLUE SHIELD
34044700MedicaidWI

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
I20101004001160 MN Practitioner - Pediatric Medicine 2567654981 Reassigns benefits to 4 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince Jan 1, 2019 Accepting new patients
Fairview Express Care Current Accepting new patients
Leap Pediatric and Adolescent Care CurrentSince Apr 6, 2024 Accepting new patients
Fairview Express Care CurrentSince Jan 1, 2019 Accepting new patients
University of Minnesota Health Clinics and Surgery Center, Inc. CurrentSince Jan 1, 2019 Accepting new patients
University of Minnesota Physicians Current Accepting new patients
Fairview Express Care CurrentSince Jan 1, 2019 Accepting new patients
Fairview Health Services Past Accepting new patients

Locations

606 24th Ave S
Minneapolis, MN 55454
Phone (612) 273-3332

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

420 Delaware St SE
#126
Minneapolis, MN 55455
Phone (612) 626-2378

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

2512 S 7th St
Minneapolis, MN 55454
Phone (612) 273-4277

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

720 Washington Ave SE
Ste 300
Minneapolis, MN 55414
Phone (612) 884-0769

450 Syndicate St N
Ste 250
Saint Paul, MN 55104
Phone (651) 242-2849

Interoperability endpoints

  • Direct secure messaging: drscal@lpaac-mn.direct.office.nextgen.com

Organizations & group practices 8

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": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537228800000",
    "number": "1619077484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 WASHINGTON AVE SE STE 300",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554142904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2512 S 7TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541404",
            "telephone_number": "612-365-6777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCAL",
        "first_name": "PETER",
        "middle_name": "BENJAMIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2018-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "40605",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAIRVIEW",
            "identifier": "136416",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7777470",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1025762",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0060411",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10387",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARAZ",
            "identifier": "1163348",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP31785",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA CHOICE",
            "identifier": "12-00978",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA PRIMARY",
            "identifier": "12-09026",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "151276",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "764415900",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0535047",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "025A6SC",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34044700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.