North Star Podiatric Lab, Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

NORTH STAR PODIATRIC LAB, INC.

Practice address

13419 Fenway Blvd N
Suite 101
Hugo, MN 55038-7465

Phone

(651) 426-9388

Fax

(651) 426-7450

NPI assigned

Jul 5, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Terri Wagner, CP

Title

Certified Pedorthist

Phone

(651) 426-9388

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

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

Medicare medical equipment & supply locations

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1962409995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13419 FENWAY BLVD N",
            "address_2": "SUITE 101",
            "city": "HUGO",
            "state": "MN",
            "postal_code": "550387465",
            "telephone_number": "651-426-9388",
            "fax_number": "651-426-7450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13419 FENWAY BLVD N",
            "address_2": "SUITE 101",
            "city": "HUGO",
            "state": "MN",
            "postal_code": "550387465",
            "telephone_number": "651-426-9388",
            "fax_number": "651-426-7450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH STAR PODIATRIC LAB, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-05",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "TERRI",
        "authorized_official_title_or_position": "CERTIFIED PEDORTHIST",
        "authorized_official_telephone_number": "651-426-9388",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CP"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "908817200",
            "state": "FM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "26569NO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS PROVIDER",
            "identifier": "66",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "METRO HEALTH PLAN PROV NU",
            "identifier": "418173203",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA PROVIDER NUMBER",
            "identifier": "8214553",
            "state": "FM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kylee Marie Munson
• Ku Gay Nahpay
• Isabelle Alan Nelson
• Linh Nguyen
• Ayala Nogueira, OTR/L
• Northeast Eye Care of Hugo
• John T Northwood, MD
• Volodymyr Oleksovskyi
• Oneka Chiropractic, PA
• Liza Milagros Ortiz, M.D., M.P.H.

• Prosthetic/Orthotic Supplier in Hugo, MN
• Providers in Hugo, MN by specialty
• Prosthetic/Orthotic Supplier in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.