CHILD AND TEEN MEDICAL CENTER
NPI 1225158520
Pediatrics in Blaine, MN
NPI Status: Active since March 30, 2007
Contact Information
11107 ULYSSES ST NE STE 100
BLAINE, MN
ZIP 55434
Phone: (763) 333-7733
Fax: (763) 333-7711
- Organization
- Pediatrics
- Accepts Insurance
- CLIA Number: 24D0402828
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 12-22-2025
About CHILD AND TEEN MEDICAL CENTER
This page provides the complete NPI Profile along with additional information for Child And Teen Medical Center, a pediatrician established in Blaine, Minnesota operating as a Pediatrics. The healthcare provider is registered in the NPI registry with number 1225158520 assigned on March 2007. The practitioner's primary taxonomy code is 208000000X. The provider is registered as an organization and their NPI record was last updated 4 years ago. The provider's former legal business name is Fridley Children's And Teenagers' Medical Center Pa. The authorized official of this NPI record is Mrs. Angela Marie Bennett Ba (Practic Administrator)
- NPI
- 1225158520
- Provider Legal Name
- CHILD AND TEEN MEDICAL CENTER
- Other Organization Name
- FRIDLEY CHILDREN'S AND TEENAGERS' MEDICAL CENTER PA
- Other Name Type
- Former Legal Business Name (4)
- Entity Type
- Organization
- Location Address
- 11107 ULYSSES ST NE STE 100 BLAINE, MN 55434
- Location Phone
- (763) 333-7733
- Location Fax
- (763) 333-7711
- Mailing Address
- 11107 ULYSSES ST NE STE 100 BLAINE, MN 55434
- Mailing Phone
- (763) 333-7733
- Mailing Fax
- (763) 333-7711
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 03-30-2007
- Last Update Date
- 08-24-2021
- Code Navigator
A pediatrician like Child And Teen Medical Center is a physician who has completed a pediatric residency and is board-certified or board-eligible in a pediatric specialty. Pediatric care providers are trained to care for newborns, infants, children and adolescents. A pediatrician could perform physical exams, manage vaccinations, monitor development milestones, diagnose illnesses, infections, injuries or other health problems, etc.
Location Map
Secondary Locations
- 7225 University Ave NE
Fridley, MN 55432
(763) 333-7733
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Pediatrics
- Taxonomy Code
- 208000000X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 261QM2500X | Ambulatory Health Care Facilities | Clinic/Center |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Atlas $1,000 Gold - PPO
- Atlas $1,500 Standard Gold - PPO
- Atlas $2,650 Plus Silver - PPO
- Atlas $3,500 HSA Silver - PPO
- Atlas $5,000 Standard Silver - PPO
- Atlas $6,500 Plus Bronze - PPO
- Atlas $7,500 Standard Bronze - PPO
- Atlas $8,200 HSA Bronze - PPO
- Atlas $9,200 Catastrophic - PPO
- Medica Individual Choice Bronze $0 Copay PCP Visits - HMO
- Medica Individual Choice Bronze Share - HMO
- Medica Individual Choice Expanded Bronze Standard - HMO
- Medica Individual Choice Gold $0 Copay PCP Visits - HMO
- Medica Individual Choice Gold Share - HMO
- Medica Individual Choice Gold Standard - HMO
- Medica Individual Choice Silver $0 Copay PCP Visits - HMO
- Medica Individual Choice Silver Share - HMO
- Medica Individual Choice Silver Standard - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 24D0402828
- Facility Type
- Physician Office
- Certificate Effective Date
- December 23, 2023
- Certificate Expiration Date
- December 22, 2025
- Laboratory Director
- DR. STEPHEN B. SITRIN
- Certificate Type
- Certificate of Accreditation
- Certificate Type Description
- This is a CLIA certificate is issued to Child And Teen Medical Center on the basis of the laboratory's accreditation by an accreditation organization approved by CMS. This type of certificate is issued to a laboratories tha perform nonwaived (moderate and/or high complexity) testing.
Reviews for CHILD AND TEEN MEDICAL CENTER
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 2 | 2 | 5 | 1 | 5 | 8 | 5 | 2 | 0 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 2 | 4 | 5 | 2 | 5 | 16 | 5 | 4 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 2 + 4 + 5 + 2 + 5 + 1 + 6 + 5 + 4 + 24 = 60 | |||||||||
| Step 3: because the number obtained in step 2 ends in zero, the check digit is zero. | |||||||||
| 0 | |||||||||
The NPI number 1225158520 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 7 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1285887653 | DR. JENNIFER ELAINE ROUSSEAU M.D. Individual | Pediatrics | 11107 ULYSSES ST NE STE 100 BLAINE, MN 55434 (763) 333-7733 |
| 1366440257 | DR. STEPHEN SITRIN M.D. Individual | Pediatrics | 11107 ULYSSES ST NE STE 100 BLAINE, MN 55434 (763) 333-7733 |
| 1619938396 | FADEL SAKKAL MD Individual | Pediatrics | 11107 ULYSSES ST NE STE 100 BLAINE, MN 55434 (763) 333-7723 |
| 1942317888 | JOHN ROBERT HOLLERUD M.D. Individual | Pediatrics | 11107 ULYSSES ST NE STE 100 BLAINE, MN 55434 (763) 333-7733 |
| 1376299107 | BENJAMIN JEROME WILLIAMS Individual | Nurse Practitioner (Pediatrics) | 11107 ULYSSES ST NE STE 100 BLAINE, MN 55434 (763) 333-7733 |
| 1720432768 | MISS KAYLEE MICHAEL ADAMS DNP, APRN, NNP-BC Individual | Nurse Practitioner (Pediatrics) | 11107 ULYSSES ST NE STE 100 BLAINE, MN 55434 (763) 333-7721 |
| 1962276964 | DANIELLE NICOLE THURMAN CPNP Individual | Pediatrics | 11107 ULYSSES ST NE STE 100 BLAINE, MN 55434 (763) 333-7733 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1225158520, enumerated in the NPI registry as an "organization" on March 30, 2007
The provider is located at 11107 Ulysses St Ne Ste 100 Blaine, Mn 55434 and the phone number is (763) 333-7733
This medical organization specializes in Pediatrics with taxonomy code 208000000X
The provider might be accepting Accepts: HealthPartners and Medica. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 24D0402828 for a "physician office" facility with a CLIA Certificate of Accreditation. This is a CLIA certificate is issued on the basis of the laboratory's accreditation by an accreditation organization approved by CMS. This type of certificate is issued to a laboratories tha perform nonwaived (moderate and/or high complexity) testing..
This NPI record was last updated on March 30, 2007. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.