Pediatric and Young Adult Medicine, PA

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

154 Issued in MN

Legal business name

PEDIATRIC AND YOUNG ADULT MEDICINE, PA

Practice address

1804 7TH St W
Suite 200
Saint Paul, MN 55116-2300

Phone

(651) 227-7806

Fax

(651) 256-6766

NPI assigned

May 17, 2007

Last updated

Dec 7, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Terri M Joseph

Title

Clinic Administrator

Phone

(651) 256-6706

Specialties & licenses 1

Addresses

Other identifiers 10

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Pediatric and Young Adult Medicine PA5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

• Pediatric and Young Adult Medicine, PA

  • Primary Care Clinic/Center
  • Eagan, MN
  • NPI 1205078300
  NPD tax ID
• Pediatric and Young Adult Medicine, PA

  • Primary Care Clinic/Center
  • Maplewood, MN
  • NPI 1295977395
  NPD tax ID
• Pediatric and Young Adult Medicine, PA

  • Primary Care Clinic/Center
  • Lake Elmo, MN
  • NPI 1457593550
  NPD tax ID
• Pediatric and Young Adult Medicine, PA

  • Primary Care Clinic/Center
  • Hudson, WI
  • NPI 1710129812
  NPD tax ID

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481068800000",
    "number": "1932316916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 7TH ST W",
            "address_2": "SUITE 200",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551162300",
            "telephone_number": "651-227-7806",
            "fax_number": "651-256-6766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1804 7TH ST W",
            "address_2": "SUITE 200",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551162300",
            "telephone_number": "651-227-7806",
            "fax_number": "651-256-6766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC AND YOUNG ADULT MEDICINE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2016-12-07",
        "status": "A",
        "authorized_official_last_name": "JOSEPH",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "651-256-6706",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MN",
            "license": "154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083694046",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245210210",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912987900",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104806165",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245210095",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477870921",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881057065",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497735419",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861558835",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386991339",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracy Pedersen, M.S., CCC-SLP
• Melissa Wheelock Pederson, PH.D., L.P.
• Patrick Pederson
• Pediatric & Adolescent Care of MN., P.a.
• Pediatric Acupuncture and Wellness Center
• Pediatric Orthopaedic Associates
• Pediatric Rehabilitation Associates
• Maia Nicole Pedrosa
• Kamber Peerboom, LICSW
• Danielle Marie Peick, NP

• Primary Care Clinic/Center in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Primary Care Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2016; 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.