Northeast Pediatric Clinic – Primary Care Clinic/Center, NPI 1477869311

Primary Care Clinic/Center

Northeast Pediatric Clinic is a healthcare provider. based in Roseville, Minnesota. specializing in Primary Care Clinic/Center. The organization holds a License No. 347125 (MN). The NPI Number for Northeast Pediatric Clinic is 1477869311

Main info

Organization

Name

Northeast Pediatric Clinic

NPI

1477869311

Phone

(651) 855-2109

Address

2910 CENTRE POINTE DR

Authorized Official

JERRY L MASSMANN CFO

Enumeration Date

30 August 2010

Last Update Date

31 October 2022

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience54

Completeness80

Years active:15State licenses:1Digital endpointsUpdated within 12 months

Provider Addresses for Northeast Pediatric Clinic

2910 CENTRE POINTE DR
ROSEVILLE, MN 551131182
Phone: (651) 855-2109
Fax: (651) 855-2310
Type: Mailing
4520 CENTERVILLE RD
VADNAIS HEIGHTS, MN 551273602
Phone: (651) 426-1141
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55113)

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Reviews

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Frequently asked questions

Where can patients find Northeast Pediatric Clinic's NPI?

You can confirm Northeast Pediatric Clinic with NPI 1477869311; it appears in the national provider directory.

Is Northeast Pediatric Clinic's enrollment marked active?

An active flag here means the NPI record is not in a deactivated state.

Can you summarize Northeast Pediatric Clinic's specialty in plain language?

Clinically, the directory lists Northeast Pediatric Clinic with Primary Care Clinic/Center. Clinical services aligned with this taxonomy classification.

Where is Northeast Pediatric Clinic's primary listing?

We display Roseville, Minnesota because that is what the record indicates for Northeast Pediatric Clinic.

How can I contact Northeast Pediatric Clinic?

Phone or fax may appear on the official NPI record when supplied — verify before relying on them.