NPIMap

Organization Active NPI

Minnetonka Pediatric Therapy Center, LLC

  • Speech-Language Pathologist
  • Plymouth, MN
National Provider Identifier
1891998035
Registry record updated Jan 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
MINNETONKA PEDIATRIC THERAPY CENTER, LLC
Practice address
15600 36TH Ave N Ste 120
Plymouth, MN 55446-3687
Phone
(763) 595-0812
Fax
(763) 595-0824
NPI assigned
Jun 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2021

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

Authorized official

Name
Mrs. Kaye M Baumgardner, MS. CCC-SLP/COM
Title
Owner/Speech Pathologist
Phone
(763) 595-0812

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X MN
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X MN
Pediatric Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0200X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X MN Primary

Addresses

Primary practice location

15600 36TH Ave N Ste 120
Plymouth, MN 55446-3687

Mailing address

15600 36TH Ave N Ste 120
Plymouth, MN 55446-3687
Phone (763) 595-0812

Other identifiers 1

IdentifierTypeStateIssuer
323915000MedicaidMN

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL info@minnetonkatherapy.com Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150827000425 MN Part B Supplier - Clinic/Group Practice 6103132782 Receives reassigned benefits from 8 practitioners
Practice locations: Plymouth, MN

National Provider Directory

National Provider Directory

Locations

15600 36th Ave N
Ste 120
Plymouth, MN 55446
Phone (763) 595-0812

11140 Highway 55
Ste C
Plymouth, MN 55441
Phone (763) 595-0812

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611878400000",
    "number": "1891998035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15600 36TH AVE N STE 120",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463687",
            "telephone_number": "763-595-0812",
            "fax_number": "763-595-0824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15600 36TH AVE N STE 120",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463687",
            "telephone_number": "763-595-0812",
            "fax_number": "763-595-0824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNETONKA PEDIATRIC THERAPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2021-01-29",
        "certification_date": "2021-01-29",
        "status": "A",
        "authorized_official_last_name": "BAUMGARDNER",
        "authorized_official_first_name": "KAYE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/SPEECH PATHOLOGIST",
        "authorized_official_telephone_number": "763-595-0812",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MS. CCC-SLP/COM"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "323915000",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "info@minnetonkatherapy.com",
            "affiliation": "N",
            "endpointDescription": "secure email to send information",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "15600 36th Ave N Ste 120",
            "city": "Plymouth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554463687",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.