1. Home
  2. Directory
  3. Minnesota
  4. Saint Paul
  5. Dentist
  6. NPI Profile

DR. TARA VONNE BRODERSEN DDS
NPI 1336138882
Dentist - General Practice in Saint Paul, MN

Active since October 18, 2005PECOS Enrolled
200 UNIVERSITY AVE E, SAINT PAUL, MN 55101(651) 291-2848(651) 602-6885 Get Directions Write a Review

NPPES record last updated: March 8, 2019. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Dr. Tara Vonne Brodersen Dds NPPES

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

DR. TARA VONNE BRODERSEN DDS (NPI 1336138882) is an individual general practice provider in Saint Paul, Minnesota, licensed in Minnesota (D11913) and active in the NPI registry since October 2005. She is enrolled in Medicare PECOS and maintains a secondary practice location in Bloomington.

NPPES Registry Identity

NPI1336138882
Entity TypeIndividualFemale
Primary Taxonomy1223G0001X
Provider Legal NameDR. TARA VONNE BRODERSENCredential: DDS
Location Address200 UNIVERSITY AVE ESaint Paul, MN 55101-2507
Mailing Address200 University Ave ESaint Paul, MN 55101-2507 · (651) 291-2848 · Fax (651) 602-6885
Phone(651) 291-2848
Fax(651) 602-6885
Sole ProprietorYes
Enumeration DateOctober 18, 2005
Last NPPES UpdateMarch 8, 2019
✔ NPI 1336138882 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in MN · D11913
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
200 UNIVERSITY AVE E, Saint Paul, MN 55101
Open in Google Maps ↗

Secondary Practice Location 1

Location 15320 Hyland Greens Dr Ste 200Bloomington, MN 55437-3935 · Phone (952) 831-6126

Other Identifiers 1

OtherH400538336MN · Medicare Upin

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Tara Vonne Brodersen Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Tara Brodersen reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Gillette Children's Specialty Healthcare
Same address
Multi-Specialty
200 EAST UNIVERSITY AVE
St. Paul, MN 55101
  • Reassigned Medicare billing, Minnesota enrollment
  • Medicare enrollment name: Gillette Childrens Specialty Healthcare
  • 304 clinicians in this Medicare group
NPI 1225119175 (651) 291-2848

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55101 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.82 typical visit price
range $56.00 – $168.28
Typical copayment $21.45 (range $14.00 – $42.07)
Most-billed visit code 99203
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

CAMILLE FENG
Social Worker (Clinical)
200 UNIVERSITY AVE E
SAINT PAUL, MN 55101
Ramsey County (651) 312-3169
EMILY MARIE SCHAAF M.D.
Pediatrics (Pediatric Infectious Diseases)
200 UNIVERSITY AVE E
SAINT PAUL, MN 55101
Ramsey County (651) 578-5258
DANIELLE HARDING PA-C
Physician Assistant
200 UNIVERSITY AVE E
SAINT PAUL, MN 55101
Ramsey County (651) 290-8707
NATALIE PAULSON RN, CPN
Registered Nurse (Pediatrics)
200 UNIVERSITY AVE E
SAINT PAUL, MN 55101
Ramsey County (651) 229-3820
STEPHANIE K CAMPBELL
Dietitian, Registered
200 UNIVERSITY AVE E
SAINT PAUL, MN 55101
Ramsey County (651) 229-3933
BETTY J ONG MD
Psychiatry & Neurology (Neurology with Special Qualifications in Child Neurology)
200 UNIVERSITY AVE E
SAINT PAUL, MN 55101
Ramsey County (651) 325-2121
MRS. KIMBERLY FARNHAM RNFA
Registered Nurse (Registered Nurse First Assistant)
200 UNIVERSITY AVE E
SAINT PAUL, MN 55101
Ramsey County (651) 229-3864
MR. TRENTON CHARLES COOPER DO
Orthopaedic Surgery
200 UNIVERSITY AVE E
SAINT PAUL, MN 55101
Ramsey County (651) 726-2663

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 Tara Brodersen's NPI number?

The NPI number for Tara Brodersen is 1336138882. It was assigned to this individual provider in the NPPES registry on October 18, 2005.

Where is Tara Brodersen located?

Tara Brodersen practices at 200 University Ave E, Saint Paul, MN 55101. The listed phone number is (651) 291-2848.

What is Tara Brodersen's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Tara Brodersen enrolled in Medicare?

Yes. Tara Brodersen is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Tara Brodersen's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Tara Brodersen reassigns Medicare benefits to Gillette Children's Specialty Healthcare (St. Paul, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Tara Brodersen's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Tara Brodersen accept?

Health plans from BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Florida Combined Life and 11 other insurers list Tara Brodersen 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 Tara Brodersen was last updated on March 8, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.