NPIMap

Organization Active NPI

New Kingdom Pediatrics LLC

  • Clinic/Center
  • Eden Prairie, MN
National Provider Identifier
1760816045
Registry record updated Aug 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
44503 Issued in MN
Legal business name
NEW KINGDOM PEDIATRICS LLC
Practice address
6452 City West Pkwy
Eden Prairie, MN 55344-3245
Phone
(952) 999-0333
NPI assigned
Aug 22, 2013
Last updated
Aug 22, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2013

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

Authorized official

Name
Robert Zajac, MDNPI 1578551636
Title
Ceo
Phone
(952) 412-4229

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 44503 MN Primary

Addresses

Primary practice location

6452 City West Pkwy
Eden Prairie, MN 55344-3245

Mailing address

6452 City West Pkwy
Eden Prairie, MN 55344-3245
Phone (952) 999-0333

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150505001812 MN Part B Supplier - Clinic/Group Practice 7315266806 Receives reassigned benefits from 29 practitioners
Practice locations: Albertville, MN; Alexandria, MN; Burnsville, MN; Eden Prairie, MN; North Branch, MN

National Provider Directory

National Provider Directory

Locations

10904 57th St NE
Ste 106
Albertville, MN 55301
Phone (763) 497-0733

410 30th Ave E
Ste 201
Alexandria, MN 56308
Phone (952) 999-0333

510 22nd Ave E
Ste 103
Alexandria, MN 56308
Phone (952) 999-0333

10904 Baltimore St NE
Blaine, MN 55449

6452 City West Pkwy
Eden Prairie, MN 55344
Phone (952) 999-0333

38500 Tanger Dr
Ste 106
North Branch, MN 55056
Phone (952) 999-0333

38500 Tanger Dr
Ste 108
North Branch, MN 55056

174 Lake Ave N
Spicer, MN 56288
Phone (320) 409-1330

2101 Woodwinds Dr
Ste 400B
Woodbury, MN 55125
Phone (952) 999-0333

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1377129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377129600000",
    "number": "1760816045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6452 CITY WEST PKWY",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443245",
            "telephone_number": "952-999-0333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6452 CITY WEST PKWY",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443245",
            "telephone_number": "952-999-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW KINGDOM PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-22",
        "last_updated": "2013-08-22",
        "status": "A",
        "authorized_official_last_name": "ZAJAC",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "952-412-4229",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": "44503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eden Prairie, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2013; 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.