OrganizationActive
Pediatric and Young Adult Medicine, PA
NPI 1457593550 · Primary Care Clinic/Center · Lake Elmo, MN
Provider details
- NPI number
- 1457593550
- Entity type
- Organization
- Primary specialty
- Primary Care Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Terri Joseph, Clinic Administrator(651) 256-6706
- License
- 154 (MN)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Detailed profile(85/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
17 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
8650 Hudson Blvd N
Suite 125
Lake Elmo, MN 55042-9747
Phone: (651) 256-6706
Fax: (651) 256-6707
Street-level locationGet directions
Mailing address
1804 7th St W
Saint Paul, MN 55116-2300
Registry dates
- Enumerated
- 2009-04-03
- Last updated
- 2016-12-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.