NPIMap

Organization Active NPI

St Catherine University

Doing business as St Catherine University Health and Wellness Center

  • Pediatric Adolescent Medicine Physician
  • Saint Paul, MN
National Provider Identifier
1891016481
Registry record updated Jun 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
40727 Issued in MN
Legal business name
ST CATHERINE UNIVERSITY
Doing business as
St Catherine University Health and Wellness Center
Practice address
2004 Randolph Ave
Mail #4112
Saint Paul, MN 55105-1750
Phone
(651) 690-6714
Fax
(651) 690-6188
NPI assigned
Jun 17, 2010
Last updated
Jun 17, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2010

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

Authorized official

Name
Amy M Kelly, MDNPI 1588645121
Title
MD
Phone
(651) 690-6714

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X 40727 MN Primary

Addresses

Primary practice location

2004 Randolph Ave
Mail #4112
Saint Paul, MN 55105-1750

Mailing address

2004 Randolph Ave
Mail #4112
Saint Paul, MN 55105-1750
Phone (651) 690-6714

Other names 1

  • St Catherine University Health and Wellness Center Doing business as

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0667911St Catherine University2004 Randolph Ave, Saint Paul, MN 55105Certificate of waiverNov 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
St Catherine University School Based Health Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2004 Randolph Ave
#4112
Saint Paul, MN 55105
Phone (651) 690-6714

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1276732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276732800000",
    "number": "1891016481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2004 RANDOLPH AVE",
            "address_2": "MAIL #4112",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551051750",
            "telephone_number": "651-690-6714",
            "fax_number": "651-690-6188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2004 RANDOLPH AVE",
            "address_2": "MAIL #4112",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551051750",
            "telephone_number": "651-690-6714",
            "fax_number": "651-690-6188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CATHERINE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-17",
        "last_updated": "2010-06-17",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "651-690-6714",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "MN",
            "license": "40727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Catherine University Health and Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.