Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

SOUTH LAKE CLINIC, PA
NPI 1689005902
Pediatrics in Plymouth, MN

Q: What is South Lake Clinic, PA's NPI number?

The NPI number for South Lake Clinic, PA is 1689005902. It was assigned to this organization in the NPPES registry on December 12, 2013. The provider is doing business as South Lake Pediatrics.

Q: What is South Lake Clinic, PA's specialty?

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

Active since December 12, 2013CLIA 24D0898889 · Accreditation

15535 34TH AVE N STE 100, PLYMOUTH, MN 55447(952) 401-8300(952) 401-8243 Get Directions Write a Review

NPPES record last updated: September 28, 2026. Verified against the NPPES registry weekly; last sync: October 11, 2026.

Record update history: Sep 28, 2026, Aug 29, 2023 (2 updates tracked since 2023).

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About South Lake Clinic, Pa NPPES

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

SOUTH LAKE CLINIC, PA (NPI 1689005902), doing business as South Lake Pediatrics, is a healthcare organization registered as a pediatrics in Plymouth, Minnesota and active in the NPI registry since December 2013. The organization holds an CLIA Accreditation certificate valid through January 29, 2027 and lists Michael Garvis, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1689005902

Entity TypeOrganization

Primary Taxonomy208000000X

Legal Business NameSOUTH LAKE CLINIC, PA

Location Address15535 34TH AVE N STE 100Plymouth, MN 55447-2170

Mailing Address17705 Hutchins Dr Ste 250Minnetonka, MN 55345-4103 · (952) 401-8300 · Fax (952) 401-8240

Phone(952) 401-8300

Fax(952) 401-8243

Organization SubpartNo

Authorized OfficialMichael GarvisMedical Director · (952) 401-8300

Enumeration DateDecember 12, 2013

Last NPPES UpdateSeptember 28, 20262 updates tracked since enumeration

NPPES CertifiedSeptember 28, 2026

✔ NPI 1689005902 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ 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.

15535 34TH AVE N STE 100, Plymouth, MN 55447

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Other Names 1

Doing Business AsSouth Lake Pediatrics

Accepted Insurance

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

CLIA Laboratory Certificates CMS CLIA

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 24D0898889

South Lake Pediatrics-Plymouth · Plymouth, MN

Active · expires Jan 29, 2027

CLIA Number24D0898889

Laboratory TypePhysician Office

Certificate Effective DateJanuary 30, 2025

Certificate Expiration DateJanuary 29, 2027

Laboratory DirectorMichael Garvis

Laboratory Phone(952) 401-8280

Laboratory LocationSouth Lake Pediatrics-Plymouth15535 34th Ave N Suite 100, Plymouth, MN 55447

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

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

KATHERINE ANN SEARLES DNP, APRN, CPNP-PC

Nurse Practitioner (Pediatrics)

15535 34TH AVE N STE 100
PLYMOUTH, MN 55447

Hennepin County (952) 401-8300

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 South Lake Clinic, PA's NPI number?

The NPI number for South Lake Clinic, PA is 1689005902. It was assigned to this organization in the NPPES registry on December 12, 2013. The provider is doing business as South Lake Pediatrics.

Where is South Lake Clinic, PA located?

South Lake Clinic, PA is located at 15535 34th Ave N Ste 100, Plymouth, MN 55447. The listed phone number is (952) 401-8300.

What is South Lake Clinic, PA's specialty?

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

Does South Lake Clinic, PA hold a CLIA laboratory certificate?

Yes. A Certificate of Accreditation (number 24D0898889) is associated with this NPI, valid through January 29, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does South Lake Clinic, PA accept?

Health plans from Medica list South Lake Clinic, PA 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 South Lake Clinic, PA was last updated on September 28, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 days 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.