Active NPI
Tonya Lynne Bryan, M.D.
- Pediatrics Physician
- Andover, MN
National Provider Identifier
1619939741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 43377
- Practice address
- 13819 Hanson Blvd NW
Andover, MN 55304-7608 - Phone
- (763) 572-5710
- Fax
- (763) 862-4490
- NPI assigned
- Apr 4, 2006
- Last updated
- Oct 6, 2011
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 43377 | MN | Primary |
Addresses
Primary practice location
13819 Hanson Blvd NW
Andover, MN 55304-7608
Mailing address
6401 University Ave NE
Fridley, MN 55432-4341
Phone (763) 572-5710
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Nicollet Clinic | Pediatrics | Current | Accepting new patients |
| Park Nicollet Clinic | Pediatrics | Current | Accepting new patients |
| Columbia Park Medical Group, PA | Pediatrics | Past | Accepting new patients |
Locations
5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400
3850 Park Nicollet Blvd
St Louis Park, MN 55416
Phone (952) 883-1000
Interoperability endpoints
- tbryan157228@direct.healthpartners.com
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317859200000",
"number": "1619939741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6401 UNIVERSITY AVE NE",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "554324341",
"telephone_number": "763-572-5710",
"fax_number": "763-571-3008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13819 HANSON BLVD NW",
"city": "ANDOVER",
"state": "MN",
"postal_code": "553047608",
"telephone_number": "763-572-5710",
"fax_number": "763-862-4490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRYAN",
"first_name": "TONYA",
"middle_name": "LYNNE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-04",
"last_updated": "2011-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "43377",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Andover, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.