Active NPI
Simon-Noel Ndely, MD
- Pediatric Critical Care Medicine Physician
- Minneapolis, MN
National Provider Identifier
1932605433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Critical Care Medicine Physician
- License
- 77799
- Practice address
- 2450 Riverside Ave
Minneapolis, MN 55454-1450 - Phone
- (612) 365-1000
- NPI assigned
- Apr 3, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | S479125347520 | MN | |
| Pediatrics Physician | 208000000X | 77799 | MN | |
| Pediatric Critical Care Medicine Physician | 2080P0203X | 77799 | MN | Primary |
Addresses
Primary practice location
2450 Riverside Ave
Minneapolis, MN 55454-1450
Mailing address
1700 University Ave W
Saint Paul, MN 55104-3727
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S479125347520 | MN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairview Health Services | Current | Accepting new patients | |
| Fairview Health Services | Current | Accepting new patients | |
| Fairview Health Services | Current | Accepting new patients |
Locations
2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838
911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313
1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740
1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273
Interoperability endpoints
- sndely368814@fairview.direct-ci.com
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Emergency Medicine Physician
- Minneapolis, MN
- NPI 1811077175
-
- General Acute Care Hospital
- Minneapolis, MN
- NPI 1013994359
-
- Land Ambulance
- Saint Paul, MN
- NPI 1710212485
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723593600000",
"number": "1932605433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1700 UNIVERSITY AVE W",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551043727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2450 RIVERSIDE AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554541450",
"telephone_number": "612-365-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NDELY",
"first_name": "SIMON-NOEL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-03",
"last_updated": "2024-08-14",
"certification_date": "2024-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "S479125347520",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "77799",
"primary": false
},
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "MN",
"license": "77799",
"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 Aug 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.