Woodbury Endocrinology and Diabetes Clinic LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

WOODBURY ENDOCRINOLOGY AND DIABETES CLINIC LLC

Practice address

539 Bielenberg Dr Ste 120
Woodbury, MN 55125-4437

Phone

(612) 425-0958

Fax

(651) 340-4233

NPI assigned

Aug 9, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Abel Alfonso, DO

Title

Ceo

Phone

(612) 425-0958

Specialties & licenses 1

Addresses

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25061/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1628467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646352000000",
    "number": "1841964277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "539 BIELENBERG DR STE 120",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254437",
            "telephone_number": "612-425-0958",
            "fax_number": "651-340-4233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "539 BIELENBERG DR STE 120",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254437",
            "telephone_number": "612-425-0958",
            "fax_number": "651-340-4233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODBURY ENDOCRINOLOGY AND DIABETES CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-09",
        "last_updated": "2022-03-04",
        "certification_date": "2022-03-04",
        "status": "A",
        "authorized_official_last_name": "ALFONSO",
        "authorized_official_first_name": "ABEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "612-425-0958",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Medical Specialty Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.