Active NPI
Samantha Ann Renfroe
- Physician Assistant
- Minneapolis, MN
National Provider Identifier
1770296808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 14613
- Practice address
- 2525 Chicago Ave
Minneapolis, MN 55404-4518 - Phone
- (612) 874-1292
- NPI assigned
- Jan 4, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 14613 | MN | Primary |
Addresses
Primary practice location
2525 Chicago Ave
Minneapolis, MN 55404-4518
Mailing address
2525 Chicago Ave
Minneapolis, MN 55404-4518
Phone (727) 254-8884
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14613 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Childrens Health Care | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Children's Hospital
- Saint Paul, MN
- NPI 1629161781
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696377600000",
"number": "1770296808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2525 CHICAGO AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554044518",
"telephone_number": "727-254-8884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2525 CHICAGO AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554044518",
"telephone_number": "612-874-1292"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENFROE",
"first_name": "SAMANTHA",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-04",
"last_updated": "2023-10-04",
"certification_date": "2023-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "14613",
"primary": true
}
],
"identifiers": [],
"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 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.