Individual provider Active NPI

Carol Lynn Meldman, D.O.

  • Internal Medicine Physician
  • Saint Paul, MN
National Provider Identifier
1972596674
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
46254 Issued in MN
Practice address
1020 Bandana Blvd W
Saint Paul, MN 55108-5107
Phone
(651) 241-9700
NPI assigned
Aug 26, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5101008552 MI
Internal Medicine Physician 207R00000X 41035021 WI
Internal Medicine Physician 207R00000X 3585 IA
Internal Medicine Physician 207R00000X 46254 MN Primary

Addresses

Primary practice location

1020 Bandana Blvd W
Saint Paul, MN 55108-5107

Mailing address

1020 Bandana Blvd W
Saint Paul, MN 55108-5107
Phone (651) 241-9700

Other identifiers 1

IdentifierTypeStateIssuer
4479866MedicaidMN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cmeldman86034@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101008552MIMDInternal Medicine Physician
46254MNMDInternal Medicine Physician
41035021WIMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1972596674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 BANDANA BLVD W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551085107",
            "telephone_number": "651-241-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 BANDANA BLVD W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551085107",
            "telephone_number": "651-241-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELDMAN",
        "first_name": "CAROL",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-26",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101008552",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "41035021",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "3585",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "46254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4479866",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cmeldman86034@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "1020 Bandana Blvd W",
            "city": "Saint Paul",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551085107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; 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.