NPIMap

Organization Active NPI

Northway Academy, Inc.

Doing business as Northway Academy, Inc. Bloomington

  • Developmental Disabilities Clinic/Center
  • Bloomington, MN
National Provider Identifier
1669056172
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
Legal business name
NORTHWAY ACADEMY, INC.
Doing business as
Northway Academy, Inc. Bloomington
Practice address
9201 Old Cedar Avenue South
Bloomington, MN 55425-2401
Phone
(952) 854-1800
Fax
(952) 945-4918
NPI assigned
May 11, 2021
Last updated
Jan 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Authorized official

Name
Mary Patricia Rodenberg-Roberts
Title
VP & Sr Asst GC
Phone
(952) 836-2234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Disabilities Clinic/Center 261QD1600X Primary

Addresses

Primary practice location

9201 Old Cedar Avenue South
Bloomington, MN 55425-2401

Mailing address

6600 France Ave S Ste 350
Edina, MN 55435-1810
Phone (952) 563-2207

Other names 1

  • Northway Academy, Inc. Bloomington Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211110002796 MN Part B Supplier - Clinic/Group Practice 6507255684 Receives reassigned benefits from 2 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sartell, MN; Saint Cloud, MN; Elk River, MN; Bloomington, MN; Duluth, MN; Alexandria, MN; Baxter, MN

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Northway Academy Inc20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Locations

9201 Old Cedar Ave S
Bloomington, MN 55425
Phone (952) 854-1800

Practitioners & affiliated clinicians

Practitioners 1

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": "1620691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705968000000",
    "number": "1669056172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 FRANCE AVE S STE 350",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554351810",
            "telephone_number": "952-563-2207",
            "fax_number": "952-922-6885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9201 OLD CEDAR AVENUE SOUTH",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554252401",
            "telephone_number": "952-854-1800",
            "fax_number": "952-945-4918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWAY ACADEMY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-11",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A",
        "authorized_official_last_name": "RODENBERG-ROBERTS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "PATRICIA",
        "authorized_official_title_or_position": "VP & SR  ASST GC",
        "authorized_official_telephone_number": "952-836-2234"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northway Academy, Inc. Bloomington",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northway Academy, Inc. Bloomington",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomington, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.