NPIMap

Organization Active NPI

Northern Lights Pediatric & Adolescent Medicine

  • Pediatric Adolescent Medicine Physician
  • Vadnais Heights, MN
National Provider Identifier
1912069519
Registry record updated May 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE
Practice address
3555 Willow Lake Blvd.
Suite 140
Vadnais Heights, MN 55110-4462
Phone
(651) 251-5280
Fax
(651) 251-5282
NPI assigned
Dec 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2009

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

Authorized official

Name
Wendy Marian Nelms McCabe, M.D.NPI 1255325213
Title
Partner
Phone
(651) 251-5280

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 PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X Primary

Addresses

Primary practice location

3555 Willow Lake Blvd.
Suite 140
Vadnais Heights, MN 55110-4462

Mailing address

3555 Willow Lake Blvd.
Suite 140
Vadnais Heights, MN 55110-4462
Phone (651) 251-5280

Other identifiers 3

IdentifierTypeStateIssuer
29960NOOtherMNBCBS MN
744432000MedicaidMN
165339OtherMNUCARE

National Provider Directory

National Provider Directory

Locations

3555 Willow Lake Blvd
Ste 140
Vadnais Heights, MN 55110
Phone (651) 770-2124

Practitioners & affiliated clinicians

Practitioners 6

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": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242777600000",
    "number": "1912069519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 WILLOW LAKE BLVD.",
            "address_2": "SUITE 140",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551104462",
            "telephone_number": "651-251-5280",
            "fax_number": "651-251-5282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 WILLOW LAKE BLVD.",
            "address_2": "SUITE 140",
            "city": "VADNAIS HEIGHTS",
            "state": "MN",
            "postal_code": "551104462",
            "telephone_number": "651-251-5280",
            "fax_number": "651-251-5282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN LIGHTS PEDIATRIC & ADOLESCENT MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2009-05-20",
        "status": "A",
        "authorized_official_last_name": "MCCABE",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "MARIAN NELMS",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "651-251-5280",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MN",
            "identifier": "29960NO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "744432000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "165339",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vadnais Heights, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2009; 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.