Individual provider Active NPI

Julia A Gourde, RN, CNP

  • Family Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1861462582
Registry record updated Apr 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R149211-2 Issued in MN
Practice address
2525 Chicago Ave
Minneapolis, MN 55404-4518
Phone
(613) 813-8430
Fax
(612) 813-6325
NPI assigned
Jan 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R149211-2 MN Primary

Addresses

Primary practice location

2525 Chicago Ave
Minneapolis, MN 55404-4518

Mailing address

2525 Chicago Ave
Minneapolis, MN 55404-4518
Phone (612) 813-8430

Other identifiers 1

IdentifierTypeStateIssuer
921497600MedicaidMN

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
I20041207000938 MN Practitioner - Nurse Practitioner 9739145103 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
May accept Medicare assignment
Group practices
Children's Health CareGroup PAC ID 2668370966, 76 clinicians

Practice addresses (Care Compare)

2530 Chicago Ave
Minneapolis, MN 55404-4289
Phone (612) 813-8800

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R149211-2MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Health Care CurrentSince Oct 19, 2015 Accepting new patients
Childrens Health Care CurrentSince Oct 19, 2015 Accepting new patients
Childrens Health Care Current Accepting new patients
Childrens Health Care Past Accepting new patients

Locations

2530 Chicago Ave
Minneapolis, MN 55404
Phone (612) 813-6000

2525 Chicago Ave
Minneapolis, MN 55404
Phone (612) 813-6000

5901 Lincoln Dr
#2
Saint Louis Park, MN 55436
Phone (952) 992-5691

347 Smith Ave N
Saint Paul, MN 55102
Phone (651) 220-6000

Organizations & group practices 4

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": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524700800000",
    "number": "1861462582",
    "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": "612-813-8430",
            "fax_number": "612-813-6325"
        },
        {
            "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": "613-813-8430",
            "fax_number": "612-813-6325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOURDE",
        "first_name": "JULIA",
        "middle_name": "A",
        "credential": "RN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-25",
        "last_updated": "2018-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R149211-2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "921497600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.