NPIMap

Summit Orthopedics, LTD

Organization Active NPI Orthopaedic Surgery Physician · Woodbury, MN

NPI 1760614242 · NPPES record last updated Oct 1, 2020

Key facts

NPI
1760614242
Entity type
Organization (NPI type 2)
Primary specialty
Orthopaedic Surgery Physician 207X00000X
Legal business name
SUMMIT ORTHOPEDICS, LTD
Practice address
2090 Woodwinds Dr
Woodbury, MN 55125-2522
Phone
(651) 968-5801
Fax
(651) 968-5899
NPI assigned
Aug 17, 2009
Organization subpart
No

Authorized official

Name
Mr. John Bien
Title
Cfo
Phone
(651) 968-5870

Other NPIs with the same Medicare PAC ID 15

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

Corporate family (same tax ID) 31

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

View all 31

Practitioners 282

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 282

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2093260Summit Orthopedics LTD
2090 Woodwinds Drive Suite 250, Woodbury, MN 55125		Certificate of waiverMar 23, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MN

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100930085714 MN DME Supplier - Physician - Orthopedic/Orthopedic Surgery 8921900374 Practice locations: Woodbury, MN

National Provider Directory

Tax ID family
Summitlandmark Orthopdc (32 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207X00000X Yes
Orthopaedic Hand Surgery Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207XS0106X
Orthopaedic Surgery of the Spine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207XS0117X
Surgery of the Hand (Surgery) Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2086S0105X
Orthopedic Physical Therapist
Group: 193200000X MULTI-SPECIALTY GROUP		 2251X0800X
Hand Occupational Therapist
Group: 193200000X MULTI-SPECIALTY GROUP		 225XH1200X
Magnetic Resonance Imaging Radiologic Technologist
Group: 193200000X MULTI-SPECIALTY GROUP		 2471M1202X

Addresses

Primary practice location

2090 Woodwinds Dr
Woodbury, MN 55125-2522

Mailing address

710 Commerce Dr Ste 200
Woodbury, MN 55125-4925
Phone (651) 968-5042

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 1, 2020.

{
    "created_epoch": "1250467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601510400000",
    "number": "1760614242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 COMMERCE DR STE 200",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254925",
            "telephone_number": "651-968-5042",
            "fax_number": "651-968-5904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2090 WOODWINDS DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252522",
            "telephone_number": "651-968-5801",
            "fax_number": "651-968-5899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT ORTHOPEDICS, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-17",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A",
        "authorized_official_last_name": "BIEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "651-968-5870",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0105X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgery of the Hand",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XH1200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Hand",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2471M1202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Magnetic Resonance Imaging",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

All providers in Woodbury, MN · Orthopaedic Surgery Physician in Minnesota

Sources for this page

Verify at the official NPI Registry.