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CHILD AND TEEN MEDICAL CENTER
NPI 1225158520
Pediatrics in Blaine, MN

Active since March 30, 2007CLIA Certified · 2 labs
11107 ULYSSES ST NE STE 100, BLAINE, MN 55434(763) 333-7733(763) 333-7711 Get Directions Write a Review

NPPES record last updated: August 24, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Aug 24, 2021, Mar 4, 2021, Apr 21, 2020 (3 updates tracked since 2020).

About Child And Teen Medical Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHILD AND TEEN MEDICAL CENTER (NPI 1225158520), doing business as Fridley Children's And Teenagers' Medical Center Pa, is a healthcare organization registered as a pediatrics in Blaine, Minnesota and active in the NPI registry since March 2007. The organization holds 2 active CLIA laboratory certificates, maintains a secondary practice location in Fridley, and lists Angela Marie Bennett, Practic Administrator, as its authorized official.

NPPES Registry Identity

NPI1225158520
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameCHILD AND TEEN MEDICAL CENTER
Location Address11107 ULYSSES ST NE STE 100Blaine, MN 55434-4184
Mailing Address11107 Ulysses St Ne Ste 100Blaine, MN 55434-4184 · (763) 333-7733 · Fax (763) 333-7711
Phone(763) 333-7733
Fax(763) 333-7711
Organization SubpartNo
Authorized OfficialAngela Marie BennettPractic Administrator · (763) 333-7755
Enumeration DateMarch 30, 2007
Last NPPES UpdateAugust 24, 20213 updates tracked since enumeration
NPPES CertifiedAugust 24, 2021
✔ NPI 1225158520 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
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.
Also ListedClinic/Center · Medical SpecialtyTaxonomy 261QM2500X
11107 ULYSSES ST NE STE 100, Blaine, MN 55434
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Other Names 1

Former Legal Business NameFridley Children's And Teenagers' Medical Center Pa

Secondary Practice Location 1

Location 17225 University Ave NEFridley, MN 55432-3134 · Phone (763) 333-7733 · Fax (763) 333-7711

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners, Medica.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Accreditation 24D2155132

Child And Teen Medical Center · Blaine, MN
Active · expires Sep 24, 2027
CLIA Number24D2155132
Laboratory TypePhysician Office
Certificate Effective DateSeptember 25, 2025
Certificate Expiration DateSeptember 24, 2027
Laboratory DirectorDr. Stephen B. Sitrin
Laboratory Phone(763) 333-7733
Laboratory LocationChild And Teen Medical Center11107 Ulysses St NE, Blaine, MN 55434
CLIA data matches this NPI record on: Address Name Phone
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate of Accreditation 24D0402828

Child And Teen Medical Center · Fridley, MN
Active · expires Dec 22, 2027
CLIA Number24D0402828
Laboratory TypePhysician Office
Certificate Effective DateDecember 23, 2025
Certificate Expiration DateDecember 22, 2027
Laboratory DirectorDr. Stephen B. Sitrin
Laboratory Phone(763) 236-2707
Laboratory LocationChild And Teen Medical Center7225 University Ave NE, Fridley, MN 55432
CLIA data matches this NPI record on: Address Name
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JENNIFER ELAINE ROUSSEAU M.D.
Pediatrics
11107 ULYSSES ST NE STE 100
BLAINE, MN 55434
Anoka County (763) 333-7733
DR. STEPHEN SITRIN M.D.
Pediatrics
11107 ULYSSES ST NE STE 100
BLAINE, MN 55434
Anoka County (763) 333-7733
BENJAMIN JEROME WILLIAMS
Nurse Practitioner (Pediatrics)
11107 ULYSSES ST NE STE 100
BLAINE, MN 55434
Anoka County (763) 333-7733
FADEL SAKKAL MD
Pediatrics
11107 ULYSSES ST NE STE 100
BLAINE, MN 55434
Anoka County (763) 333-7723
MISS KAYLEE MICHAEL ADAMS DNP, APRN, NNP-BC
Nurse Practitioner
11107 ULYSSES ST NE STE 100
BLAINE, MN 55434
Anoka County (763) 333-7721
JOHN ROBERT HOLLERUD M.D.
Pediatrics
11107 ULYSSES ST NE STE 100
BLAINE, MN 55434
Anoka County (763) 333-7733
DANIELLE NICOLE THURMAN CPNP
Pediatrics
11107 ULYSSES ST NE STE 100
BLAINE, MN 55434
Anoka County (763) 333-7733

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Child And Teen Medical Center's NPI number?

The NPI number for Child And Teen Medical Center is 1225158520. It was assigned to this organization in the NPPES registry on March 30, 2007. The provider was formerly known as Fridley Children's And Teenagers' Medical Center PA.

Where is Child And Teen Medical Center located?

Child And Teen Medical Center is located at 11107 Ulysses St NE Ste 100, Blaine, MN 55434. The listed phone number is (763) 333-7733.

What is Child And Teen Medical Center's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Child And Teen Medical Center hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Child And Teen Medical Center accept?

Health plans from HealthPartners and Medica list Child And Teen Medical Center as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Child And Teen Medical Center was last updated on August 24, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.