Tonya Lynne Bryan, M.D.
Individual provider Active NPI Pediatrics Physician · Andover, MN
NPI 1619939741 · NPPES record last updated Oct 6, 2011
Key facts
- NPI
- 1619939741
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 43377 (MN)
- Practice address
- 13819 Hanson Blvd NW
Andover, MN 55304-7608 - Phone
- (763) 572-5710
- Fax
- (763) 862-4490
- NPI assigned
- Apr 4, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051216000706 | MN | Practitioner - Pediatric Medicine | 1759302763 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43377 | MN | MD | Pediatrics Physician |
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 43377 | MN | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 128387 | Other | MN | UCARE MN |
| 59G17BR | Other | MN | BCBS OF MN |
| 011648300 | Medicaid | MN | |
| 6605841 | Other | MN | MEDICA UC |
| HP35365 | Other | MN | HEALTHPARTNERS |
| 1030993 | Other | MN | PREFERRED ONE |
| 1201818 | Other | MN | MEDICA |
| 1594350 | Other | MN | AMERICA'S PPO |
| 7978447 | Other | MN | AETNA |
Other providers in Andover, MN
- Bradley R Branham
- Kayla Braun
- Mary Breems
- Alice Marie Briley
- Jess Alan Brown
- Jessica Brysky
- Maggie Elizabeth Buechler
- Amber Courtney Buren
- Rhodessa Fidela Kabatay Burt
- Caregivers Making a Difference
All providers in Andover, MN · Pediatrics Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.