Individual provider Active NPI

Fredric Spiegel, DNP

  • Pediatric Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1902538010
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
9604 Issued in MN
Practice address
2525 Chicago Ave Ste 32-1024
Minneapolis, MN 55404-4518
Phone
(612) 813-7155
NPI assigned
Jun 28, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatric Nurse Practitioner 363LP0200X 9604 MN Primary

Addresses

Primary practice location

2525 Chicago Ave Ste 32-1024
Minneapolis, MN 55404-4518

Mailing address

959 Saint Clair Ave
Saint Paul, MN 55105-3215
Phone (612) 910-1428

Other practice location 1

345 Smith Ave N Ste 3249
Saint Paul, MN 55102-2346
Phone (612) 813-7155

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
9604MNMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1656374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1902538010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "959 SAINT CLAIR AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551053215",
            "telephone_number": "612-910-1428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 CHICAGO AVE STE 32-1024",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044518",
            "telephone_number": "612-813-7155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "345 Smith Ave N Ste 3249",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551022346",
            "country_code": "US",
            "telephone_number": "612-813-7155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPIEGEL",
        "first_name": "FREDRIC",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-28",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "9604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.