Individual provider Active NPI

Carol Marie Brunzell, RD,LDE,CDE

  • Registered Dietitian
  • Minneapolis, MN
National Provider Identifier
1689729659
Registry record updated Mar 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
724205 Issued in MN
Practice address
516 Delaware St SE
MMC 88
Minneapolis, MN 55455-0356
Phone
(612) 626-3829
NPI assigned
Jan 23, 2007
Last updated
Mar 15, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 724205 MN Primary

Addresses

Primary practice location

516 Delaware St SE
MMC 88
Minneapolis, MN 55455-0356

Mailing address

10035 Conrad Ave
Inver Grove Heights, MN 55076-3813

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060223000472 MN Practitioner - Registered Dietitian Or Nutrition Professional 4880600188 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2268MNMDChiropractor
724205MNMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince Feb 22, 2016 Accepting new patients
Fairview Health Services Dietitian, Registered CurrentSince Apr 1, 2003 Accepting new patients
University of Minnesota Health Clinics and Surgery Center, Inc. CurrentSince Feb 22, 2016 Accepting new patients
Fairview Clinics CurrentSince Oct 1, 2011 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Oct 1, 2011 Accepting new patients
Fairview Health Services CurrentSince Apr 1, 2003 Accepting new patients

Locations

201 E Nicollet Blvd
Burnsville, MN 55337
Phone (952) 892-2000

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

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

516 Delaware St SE
#88
Minneapolis, MN 55455
Phone (612) 625-4680

6401 France Ave S
Minneapolis, MN 55435
Phone (952) 920-8477

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

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

5200 Fairview Blvd
Wyoming, MN 55092
Phone (651) 464-4611

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, 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": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268611200000",
    "number": "1689729659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10035 CONRAD AVE",
            "city": "INVER GROVE HEIGHTS",
            "state": "MN",
            "postal_code": "550763813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 DELAWARE ST SE",
            "address_2": "MMC 88",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550356",
            "telephone_number": "612-626-3829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNZELL",
        "first_name": "CAROL",
        "middle_name": "MARIE",
        "credential": "RD,LDE,CDE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2010-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MN",
            "license": "724205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2010; 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.