Shriners Children's - Medicare Primary Care in Woodbury, MN

Shriners Children's is a medicare enrolled primary clinic (Clinic/center - Rehabilitation) in Woodbury, Minnesota. The current practice location for Shriners Children's is 215 Radio Dr Ste 100, Woodbury, Minnesota. For appointments, you can reach them via phone at (612) 596-6100. The mailing address for Shriners Children's is Po Box 8500 Lockbox 7642, Philadelphia, Pennsylvania and phone number is (813) 281-0300.

Shriners Children's is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1285250977. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (612) 596-6100.

Contact Information

Shriners Children's
215 Radio Dr Ste 100
Woodbury
MN 55125-5817
(612) 596-6100
Not Available

Map and Direction


Primary Care Clinic Profile

Full NameShriners Children's
SpecialityClinic/Center
Location215 Radio Dr Ste 100, Woodbury, Minnesota
Authorized Official Name and PositionJerry G. Gantt (PRESIDENT)
Authorized Official Contact8132810300
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Shriners Children's
Po Box 8500 Lockbox 7642
Philadelphia
PA 19178-1435

Ph: (813) 281-0300
Shriners Children's
215 Radio Dr Ste 100
Woodbury
MN 55125-5817

Ph: (612) 596-6100

NPI Details:

NPI Number1285250977
Provider Enumeration Date06/18/2020
Last Update Date10/28/2021

Medicare PECOS Information:

Medicare PECOS PAC ID9133031933
Medicare Enrollment IDO20140606000217

Medical Identifiers

Medical identifiers for Shriners Children's such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1285250977NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
261Q00000XClinic/center (* (Not Available))Secondary
261QR0400XClinic/center - Rehabilitation (* (Not Available))Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Shriners Children's acts as a billing entity for following providers:
Provider NameLael M Luedtke
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1285676668
PECOS PAC ID: 7214832278
Enrollment ID: I20031203000331
Provider NameDavid Wayne Polly
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1669483046
PECOS PAC ID: 2961309729
Enrollment ID: I20031218000571
Provider NameSonia Lucille Wright
Provider TypePractitioner - Diagnostic Radiology
Provider IdentifiersNPI Number: 1104804343
PECOS PAC ID: 1557323136
Enrollment ID: I20041027000760
Provider NamePeter Karachunski
Provider TypePractitioner - Neurology
Provider IdentifiersNPI Number: 1720176308
PECOS PAC ID: 7719911825
Enrollment ID: I20050919000678
Provider NameAnnalise N Larson
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1134105117
PECOS PAC ID: 0143254466
Enrollment ID: I20050926000330
Provider NameAnn E Van Heest
Provider TypePractitioner - Hand Surgery
Provider IdentifiersNPI Number: 1194833376
PECOS PAC ID: 7113942335
Enrollment ID: I20051006000879
Provider NameJennifer H Kyllo
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1679565774
PECOS PAC ID: 8224049945
Enrollment ID: I20060509000923
Provider NamePatrick C Graupman
Provider TypePractitioner - Neurosurgery
Provider IdentifiersNPI Number: 1639245822
PECOS PAC ID: 1759359243
Enrollment ID: I20070125000219
Provider NameAnne Weisensee
Provider TypePractitioner - Diagnostic Radiology
Provider IdentifiersNPI Number: 1992784755
PECOS PAC ID: 8729992433
Enrollment ID: I20080620000583
Provider NameDavid Drake
Provider TypePractitioner - Diagnostic Radiology
Provider IdentifiersNPI Number: 1528046612
PECOS PAC ID: 7517871288
Enrollment ID: I20080620000617
Provider NameRobin C Crandall
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1033131438
PECOS PAC ID: 1759327273
Enrollment ID: I20100116000254
Provider NameThomas G Mason
Provider TypePractitioner - Rheumatology
Provider IdentifiersNPI Number: 1104805522
PECOS PAC ID: 0648312280
Enrollment ID: I20100120000888
Provider NameSteven L Moran
Provider TypePractitioner - Plastic And Reconstructive Surgery
Provider IdentifiersNPI Number: 1649259557
PECOS PAC ID: 5193869352
Enrollment ID: I20100225000714
Provider NameDebbie K Song
Provider TypePractitioner - Neurosurgery
Provider IdentifiersNPI Number: 1881717973
PECOS PAC ID: 2264604842
Enrollment ID: I20111003000498
Provider NameElizabeth W Bizier
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1497782718
PECOS PAC ID: 4385664416
Enrollment ID: I20111031000772
Provider NameCary H Mielke
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1568549574
PECOS PAC ID: 4183848492
Enrollment ID: I20140606000499
Provider NameRebecca L Rouse
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1629477310
PECOS PAC ID: 3274850714
Enrollment ID: I20150323001260
Provider NameWaleed Gibreel
Provider TypePractitioner - Plastic And Reconstructive Surgery
Provider IdentifiersNPI Number: 1114367042
PECOS PAC ID: 5193967453
Enrollment ID: I20150803001878
Provider NameChristopher S Vara
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1659566479
PECOS PAC ID: 5597794149
Enrollment ID: I20150908001494
Provider NameMichael Priola
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1134321789
PECOS PAC ID: 3476725813
Enrollment ID: I20161216001170
Provider NameMatthew Basiaga
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1689800260
PECOS PAC ID: 5395900898
Enrollment ID: I20190521002755
Provider NameWendy A Tomhave
Provider TypePractitioner - Occupational Therapist In Private Practice
Provider IdentifiersNPI Number: 1780914705
PECOS PAC ID: 2062745250
Enrollment ID: I20190603001051
Provider NameSarah J Scudder
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1295210888
PECOS PAC ID: 1951634542
Enrollment ID: I20190613002058
Provider NameKari A Leifheit
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1477883130
PECOS PAC ID: 7113256223
Enrollment ID: I20190913001969
Provider NameKaile C Damm
Provider TypePractitioner - Occupational Therapist In Private Practice
Provider IdentifiersNPI Number: 1801499439
PECOS PAC ID: 0648685081
Enrollment ID: I20210218000065
Provider NameLindsay P Stephenson
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1487919643
PECOS PAC ID: 8022239987
Enrollment ID: I20220711003717
Provider NameMelissa L Forrest
Provider TypePractitioner - Physical Therapist In Private Practice
Provider IdentifiersNPI Number: 1497419873
PECOS PAC ID: 7810363157
Enrollment ID: I20221012000564
Provider NameRebecca A Kelly
Provider TypePractitioner - Occupational Therapist In Private Practice
Provider IdentifiersNPI Number: 1477199628
PECOS PAC ID: 5193193415
Enrollment ID: I20221117001783
Provider NameGregory D Kalv
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1033347638
PECOS PAC ID: 6406095066
Enrollment ID: I20221221001016
Provider NameMary L Beck
Provider TypePractitioner - Occupational Therapist In Private Practice
Provider IdentifiersNPI Number: 1659384337
PECOS PAC ID: 9335448687
Enrollment ID: I20230802002626
Provider NamePreetha Keya Sinha
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1003252198
PECOS PAC ID: 7416190152
Enrollment ID: I20240207003595
Provider NamePamela J Lang
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1073533626
PECOS PAC ID: 4183840671
Enrollment ID: I20240606000754

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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.