Individual provider Active NPI

Naomi Ann Windham, CNP

  • Family Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1801318167
Registry record updated Oct 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5225 Issued in MN
Practice address
525 Portland Ave
Minneapolis, MN 55415
Phone
(612) 348-5553
NPI assigned
Jul 8, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 1909715 MN
Family Nurse Practitioner 363LF0000X 5225 MN Primary

Addresses

Primary practice location

525 Portland Ave
Minneapolis, MN 55415

Mailing address

525 Portland Ave # Mc963
Minneapolis, MN 55415-1533
Phone (612) 348-5553

Other practice location 1

2810 Nicollet Ave
Minneapolis, MN 55408-4708
Phone (612) 873-3000

Other practice location 2

525 Portland Ave
Minneapolis, MN 55415
Phone (612) 348-5553

Other practice location 3

701 Park Ave
Minneapolis, MN 55415-1623
Phone (612) 873-6963

Other names 1

  • Naomi Ann Pederson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170815004575 MN Practitioner - Nurse Practitioner 1658643382 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hennepin CountyGroup PAC ID 7911892849, 132 clinicians

Practice addresses (Care Compare)

614 S 3Rd St
Minneapolis, MN 55415-1104
Phone (612) 348-5553

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5225MNMDMental Health Counselor
1909715MNMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Hennepin County CurrentSince Oct 28, 2019 Accepting new patients
Hennepin County Current Accepting new patients
Hennepin County CurrentSince Oct 28, 2019 Accepting new patients

Locations

701 Park Ave
Minneapolis, MN 55415
Phone (612) 873-6005

525 Portland Ave
#963
Minneapolis, MN 55415
Phone (612) 348-2233

525 Portland Ave
Minneapolis, MN 55415
Phone (612) 348-8824

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1499472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571702400000",
    "number": "1801318167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 PORTLAND AVE # MC963",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151533",
            "telephone_number": "612-348-5553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 PORTLAND AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55415",
            "telephone_number": "612-348-5553"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2810 Nicollet Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554084708",
            "country_code": "US",
            "telephone_number": "612-873-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "525 Portland Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "55415",
            "country_code": "US",
            "telephone_number": "612-348-5553",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "701 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554151623",
            "country_code": "US",
            "telephone_number": "612-873-6963",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WINDHAM",
        "first_name": "NAOMI",
        "middle_name": "ANN",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-08",
        "last_updated": "2019-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "1909715",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "5225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NAOMI",
            "last_name": "PEDERSON",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.