Active NPI
Pediatric and Young Adult Medicine, PA
- Primary Care Clinic/Center
- Hudson, WI
National Provider Identifier
1710129812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Care Clinic/Center
- License
- 154
- Legal business name
- PEDIATRIC AND YOUNG ADULT MEDICINE, PA
- Practice address
- 1610 Maxwell Dr
Suite 245
Hudson, WI 54016-8709 - Phone
- (651) 256-6706
- Fax
- (651) 256-6707
- NPI assigned
- Apr 3, 2009
- Last updated
- Dec 7, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Terri M Joseph
- Title
- Clinic Administrator
- Phone
- (651) 256-6706
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 154 | MN | Primary |
Addresses
Primary practice location
1610 Maxwell Dr
Suite 245
Hudson, WI 54016-8709
Mailing address
1804 7TH St W
Saint Paul, MN 55116-2300
Phone (651) 256-6706
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245210210 | Medicaid | MN | |
| 1497735419 | Medicaid | MN | |
| 1245210095 | Medicaid | MN | |
| 1881057065 | Medicaid | MN | |
| 1104806165 | Medicaid | MN | |
| 1083694046 | Medicaid | MN | |
| 1861558835 | Medicaid | MN | |
| 1912987900 | Medicaid | MN | |
| 1386991339 | Medicaid | MN | |
| 1477870921 | Medicaid | MN |
National Provider Directory
National Provider Directory- Tax ID family
- Pediatric and Young Adult Medicine PA
Other organizations with this tax ID 4
Organizations that report the same tax identification number in the National Provider Directory.
-
- Primary Care Clinic/Center
- Eagan, MN
- NPI 1205078300
-
- Primary Care Clinic/Center
- Maplewood, MN
- NPI 1295977395
-
- Primary Care Clinic/Center
- Lake Elmo, MN
- NPI 1457593550
-
- Primary Care Clinic/Center
- Saint Paul, MN
- NPI 1932316916
Locations
1804 7th St W
Saint Paul, MN 55116
Phone (651) 227-7806
Practitioners & affiliated clinicians
Practitioners 3
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.
-
- Pediatrics Physician
- Apple Valley, MN
- NPI 1245210095
-
- Pediatrics Physician
- Saint Paul, MN
- NPI 1245210210
-
- Pediatric Nurse Practitioner
- Golden Valley, MN
- NPI 1861558835
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1238716800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1481068800000",
"number": "1710129812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1804 7TH ST W",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551162300",
"telephone_number": "651-256-6706",
"fax_number": "651-256-6707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1610 MAXWELL DR",
"address_2": "SUITE 245",
"city": "HUDSON",
"state": "WI",
"postal_code": "540168709",
"telephone_number": "651-256-6706",
"fax_number": "651-256-6707"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PEDIATRIC AND YOUNG ADULT MEDICINE, PA",
"organizational_subpart": "NO",
"enumeration_date": "2009-04-03",
"last_updated": "2016-12-07",
"status": "A",
"authorized_official_last_name": "JOSEPH",
"authorized_official_first_name": "TERRI",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
"authorized_official_telephone_number": "651-256-6706",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "261QP2300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Primary Care",
"state": "MN",
"license": "154",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1245210210",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1497735419",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1245210095",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1881057065",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1104806165",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1083694046",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1861558835",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1912987900",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1386991339",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1477870921",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hudson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.