Individual provider Active NPI

Kendra Lynn Gram, M.D.

  • Pediatric Critical Care Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1942422787
Registry record updated Feb 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
49308 Issued in MN
Practice address
2530 Chicago Ave
Suite 400
Minneapolis, MN 55404-4289
Phone
(612) 813-3300
Fax
(612) 813-3349
NPI assigned
May 2, 2007
Last updated
Feb 22, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X 49308 MN Primary

Addresses

Primary practice location

2530 Chicago Ave
Suite 400
Minneapolis, MN 55404-4289

Mailing address

2530 Chicago Ave
Suite 400
Minneapolis, MN 55404-4289
Phone (612) 813-3300

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070718000265 MN Practitioner - Critical Care (Intensivists)Practitioner - Pediatric Medicine 3375644578 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Respiratory & Critical Care Specialists. P.a. CurrentSince Mar 28, 2011 Accepting new patients
Children's Health Care CurrentSince Apr 1, 2020 Accepting new patients
Childrens Health Care CurrentSince Apr 1, 2020 Accepting new patients
Childrens Health Care Current Accepting new patients

Locations

2525 Chicago Ave
Minneapolis, MN 55404
Phone (612) 813-6000

2530 Chicago Ave
Ste 400
Minneapolis, MN 55404
Phone (612) 813-3300

5901 Lincoln Dr
#2
Saint Louis Park, MN 55436
Phone (952) 992-5691

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298332800000",
    "number": "1942422787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 CHICAGO AVE",
            "address_2": "SUITE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044289",
            "telephone_number": "612-813-3300",
            "fax_number": "612-813-3349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 CHICAGO AVE",
            "address_2": "SUITE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044289",
            "telephone_number": "612-813-3300",
            "fax_number": "612-813-3349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAM",
        "first_name": "KENDRA",
        "middle_name": "LYNN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2011-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "MN",
            "license": "49308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.