NPIMap

Organization Active NPI

Gillette Children's Specialty Healthcare

  • Customized Equipment (DME)
  • Baxter, MN
National Provider Identifier
1801109012
Registry record updated Dec 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
Legal business name
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Practice address
15860 Audubon Way
Baxter, MN 56401-6943
Phone
(218) 824-5001
Fax
(651) 325-2174
NPI assigned
Jul 16, 2010
Last updated
Dec 13, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
GILLETTE CHILDREN'S SPECIALTY 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
Durable Medical Equipment & Medical Supplies 332B00000X NU
Customized Equipment (DME) 332BC3200X NU Primary
Prosthetic/Orthotic Supplier 335E00000X NU

Addresses

Primary practice location

15860 Audubon Way
Baxter, MN 56401-6943

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130419000389 MN DME Supplier - HospitalDME Supplier - Certified Orth/Pros/Pedorthist 0547169211 Practice locations: Brainerd, MN

Other NPIs with the same Medicare PAC ID 8

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

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 Childrens Specialty Health15860 Audubon Way, Brainerd, MN 56401-6942(218) 824-5001 Commodes, Urinals, Bedpans|Wheelchairs (Standard Manual Related Accessories)|Wheelchairs (Standard Power Related Accessories)|Wheelchairs (Complex Rehab Manual Rel Accessories)|Wheelchairs (Complex Rehab Power Rel Accessories)|Orthoses: Custom Fabricated|Orthoses: Off-The-Shelf|Limb Prostheses|Diab… 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.

Locations

15860 Audubon Way
Brainerd, MN 56401
Phone (218) 454-0088

NPI Registry JSON

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

{
    "created_epoch": "1279238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576195200000",
    "number": "1801109012",
    "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": "15860 AUDUBON WAY",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564016943",
            "telephone_number": "218-824-5001",
            "fax_number": "651-325-2174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GILLETTE CHILDREN'S SPECIALTY HEALTHCARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GILLETTE CHILDREN'S SPECIALTY HEALTHCARE",
        "enumeration_date": "2010-07-16",
        "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": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baxter, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.