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  7. NPI Record 1699395780

SAMUEL RENIER
Complete NPI Record 1699395780
Family Medicine - Sports Medicine in Woodbury, MN

NPI Status: Active since April 20, 2020

Contact Information

155 RADIO DR
WOODBURY, MN
ZIP 55125
Phone: (952) 831-8742

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider First Line Business Practice Location Address
  11. Provider Business Practice Location Address City Name
  12. Provider Business Practice Location Address State Name
  13. Provider Business Practice Location Address Postal Code
  14. Provider Business Practice Location Address Country Code If outside U S
  15. Provider Business Practice Location Address Telephone Number
  16. Provider Enumeration Date
  17. Last Update Date
  18. Provider Gender Code
  19. Healthcare Provider Taxonomy Code 1
  20. Provider License Number 1
  21. Provider License Number State Code 1
  22. Healthcare Provider Primary Taxonomy Switch 1
  23. Healthcare Provider Taxonomy Code 2
  24. Healthcare Provider Primary Taxonomy Switch 2
  25. Healthcare Provider Taxonomy Code 3
  26. Provider License Number 3
  27. Provider License Number State Code 3
  28. Healthcare Provider Primary Taxonomy Switch 3
  29. Is Sole Proprietor
  30. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1699395780. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1699395780
The code designating the provider’s gender if the provider is a person.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: SAMUEL
The first name of the provider, if the provider is an individual.
Provider First Line Business Mailing Address: 8170 33RD AVE S # MS 21110Q
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: BLOOMINGTON
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: MN
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 554254516
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider First Line Business Practice Location Address: 155 RADIO DR
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: WOODBURY
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: MN
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 551252619
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Practice Location Address Country Code If outside U S : US
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Practice Location Address Telephone Number: 9528318742
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Enumeration Date: 4/20/2020
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Last Update Date: 9/9/2024
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Gender Code: M
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 207Q00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: DR.0070456
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: CO
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 390200000X
Healthcare Provider Primary Taxonomy Switch 2: N
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 3: 207QS0010X
The date that a record was last updated or changed.
Provider License Number 3: 69921
The code designating the provider’s gender if the provider is a person.
Provider License Number State Code 3: MN
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 3: Y
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Is Sole Proprietor: Y
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
NPI Certification Date: 9/9/2024