NPIMap

Organization Active NPI

Childrens Health Care

  • Adolescent and Children Mental Health Clinic/Center
  • Minneapolis, MN
National Provider Identifier
1689778912
Registry record updated Oct 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
331018 Issued in MN
Legal business name
CHILDRENS HEALTH CARE
Practice address
2525 Chicago Ave S
Childrens Speciality Clinic Psychological Services MPLS
Minneapolis, MN 55404
Phone
(612) 813-8455
Fax
(612) 813-8263
NPI assigned
Sep 8, 2006
Last updated
Oct 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2022

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

Authorized official

Name
Brenda Lu Alexander McCormick
Title
Sr. VP and Chief Financial Officer
Phone
(612) 813-6129

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 331018 MN
Adolescent and Children Mental Health Clinic/Center 261QM0855X 331018 MN Primary

Addresses

Primary practice location

2525 Chicago Ave S
Childrens Speciality Clinic Psychological Services MPLS
Minneapolis, MN 55404

Mailing address

5901 Lincoln Drive, CBC-2-Rev/Pe
Edina, MN 55436-1611
Phone (952) 992-5691

Other practice location 1

345 Smith Ave N
Saint Paul, MN 55102-2346
Phone (651) 220-6000

Other identifiers 1

IdentifierTypeStateIssuer
435247500MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040406000939 MN Part B Supplier - Clinic/Group Practice 2668370966 Receives reassigned benefits from 570 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Paul, MN; Minneapolis, MN; Minnetonka, MN; Robbinsdale, MN; Saint Cloud, MN; St Paul, MN; Woodbury, MN; Duluth, MN…

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory
Tax ID family
Childrens Health Care28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

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

View all 27

Practitioners & affiliated clinicians

Practitioners 70

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.

View all 70

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667174400000",
    "number": "1689778912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 LINCOLN DRIVE, CBC-2-REV/PE",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554361611",
            "telephone_number": "952-992-5691",
            "fax_number": "952-992-6917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 CHICAGO AVE S",
            "address_2": "CHILDRENS SPECIALITY CLINIC PSYCHOLOGICAL SERVICES MPLS",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55404",
            "telephone_number": "612-813-8455",
            "fax_number": "612-813-8263"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "345 Smith Ave N",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551022346",
            "country_code": "US",
            "telephone_number": "651-220-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHILDRENS HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-08",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A",
        "authorized_official_last_name": "MCCORMICK",
        "authorized_official_first_name": "BRENDA LU",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "SR. VP AND CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "612-813-6129"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MN",
            "license": "331018",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "MN",
            "license": "331018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "435247500",
            "state": "MN"
        }
    ],
    "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 Oct 31, 2022; 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.