NPIMap

Organization Active NPI

Gillette Children's Specialty Healthcare

Doing business as Gillette Children's Healthcare-Burnsville

  • Multi-Specialty Clinic/Center
  • Burnsville, MN
National Provider Identifier
1740349042
Registry record updated Dec 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Doing business as
Gillette Children's Healthcare-Burnsville
Practice address
305 E Nicollet Blvd
Suite 200
Burnsville, MN 55337-8327
Phone
(952) 223-3400
Fax
(952) 223-3405
NPI assigned
Dec 6, 2006
Last updated
Dec 13, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
GILLETTE CHILDREN'S SPECIALITY HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 13, 2019

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

Authorized official

Name
Patrick Nolan
Title
Cfo
Phone
(651) 312-3105

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary
Durable Medical Equipment & Medical Supplies 332B00000X MN
Customized Equipment (DME) 332BC3200X MN
Prosthetic/Orthotic Supplier 335E00000X MN

Addresses

Primary practice location

305 E Nicollet Blvd
Suite 200
Burnsville, MN 55337-8327

Mailing address

200 University Ave E
Saint Paul, MN 55101-2507
Phone (651) 291-2848

Other identifiers 5

IdentifierTypeStateIssuer
11003700MedicaidWI
1111HGIOtherBLUE CROSS BLUE SHIELD
366138000MedicaidMN
578182000MedicaidMN
41683100MedicaidWI

Other names 1

  • Gillette Children's Healthcare-Burnsville Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060505000897 MN Part A Provider - Hospital 0547169211 8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mankato, MN; St Paul, MN; Minnetonka, MN; Maple Grove, MN; Duluth, MN; Burnsville, MN
O20100930035868 MN DME Supplier - HospitalDME Supplier - Orthotic Personnel 0547169211 Practice locations: Burnsville, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740349042. Details of each certification follow.

Hospital certification: CCN 243300

Legal name
GILLETTE CHILDRENS SPECIALTY HEALTHCARE
Certification status
Active
Provider type (POS)
Hospital – Children’s
Participating since
Apr 5, 1984
Last certification
Jun 30, 1988
Beds
60
Ownership / control type
Hospital district or authority
Most recent change of ownership
Jan 3, 1989 (2 total)
Organization structure
OtherNon-profit
Enrollment address
200 University Ave E
St Paul, MN 55101-2507
Main/Primary Hospital Location
Hospital subgroups
Children’s

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Gillette Childrens Specialty HospitalCCN 243300 · All quality measures
Type
Childrens
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Gillette Children's Specialty305 E Nicollet Blvd, Burnsville, MN 55337-8337(952) 223-3400 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Accepts assignmentParticipating since Jan 1, 2009

National Provider Directory

National Provider Directory
Tax ID family
Gillette Childrens Hosp13 organizations share this tax ID, including this one
Part of
Gillette Childrens Hosp

Other organizations with this tax ID 12

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

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Patrick Nolan Individual Corporate OfficerCfo Jul 1, 2019 50%
Charissa Debow Individual W-2 Managing Employee Nov 1, 2017
Barbara Joers Individual Corporate Officer Oct 1, 2013

Practitioners & affiliated clinicians

Affiliated clinicians 74

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 74

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576195200000",
    "number": "1740349042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 UNIVERSITY AVE E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012507",
            "telephone_number": "651-291-2848",
            "fax_number": "651-325-2174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 E NICOLLET BLVD",
            "address_2": "SUITE 200",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553378327",
            "telephone_number": "952-223-3400",
            "fax_number": "952-223-3405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GILLETTE CHILDREN'S SPECIALTY HEALTHCARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GILLETTE CHILDREN'S SPECIALITY HEALTHCARE",
        "enumeration_date": "2006-12-06",
        "last_updated": "2019-12-13",
        "certification_date": "2019-12-13",
        "status": "A",
        "authorized_official_last_name": "NOLAN",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "651-312-3105"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "MN",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11003700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1111HGI",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "366138000",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "578182000",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41683100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gillette Children's Healthcare-Burnsville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Burnsville, MN

Sources for this page

Verify at the official NPI Registry.