NPIMap

Organization Active NPI

University of Minnesota Pediatric Dental Clinic

  • Dentist
  • Minneapolis, MN
National Provider Identifier
1992075287
Registry record updated Jun 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
UNIVERSITY OF MINNESOTA PEDIATRIC DENTAL CLINIC
Practice address
701 25TH Ave S
Suite 400
Minneapolis, MN 55454-1513
Phone
(651) 659-4900
Fax
(651) 659-4901
NPI assigned
Jan 4, 2012
Last updated
Jun 5, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
UMPHYSICIANSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 5, 2013

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

Authorized official

Name
Mary A Johnson
Title
Coo
Phone
(612) 884-0802

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

701 25TH Ave S
Suite 400
Minneapolis, MN 55454-1513

Mailing address

701 25TH Ave S
Suite 400
Minneapolis, MN 55454-1513
Phone (651) 659-4900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031104000532 MN Part B Supplier - Clinic/Group Practice 9830001189 Receives reassigned benefits from 1,617 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wyoming, MN; St Louis Park, MN; Saint Paul, MN; Saint Cloud, MN; Minneapolis, MN; Bloomington, MN

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
University of Minnestoa

Practitioners & affiliated clinicians

Practitioners 157

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 157

NPI Registry JSON

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

{
    "created_epoch": "1325635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370390400000",
    "number": "1992075287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 25TH AVE S",
            "address_2": "SUITE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541513",
            "telephone_number": "651-659-4900",
            "fax_number": "651-659-4901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 25TH AVE S",
            "address_2": "SUITE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541513",
            "telephone_number": "651-659-4900",
            "fax_number": "651-659-4901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF MINNESOTA PEDIATRIC DENTAL CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UMPHYSICIANS",
        "enumeration_date": "2012-01-04",
        "last_updated": "2013-06-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "612-884-0802"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "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 Jun 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.