1. Home
  2. Directory
  3. Minnesota
  4. Plymouth
  5. Pediatrics
  6. NPI Profile

SOUTH LAKE PEDIATRICS
NPI 1689005902
Pediatrics in Plymouth, MN

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 14, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About South Lake Pediatrics NPPES

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

SOUTH LAKE PEDIATRICS (NPI 1689005902) 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 Heidi Northrup, Administrator, 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 OfficialHeidi NorthrupAdministrator · (952) 401-8300
Enumeration DateDecember 12, 2013
Last NPPES UpdateSeptember 14, 2023
NPPES CertifiedSeptember 14, 2023
✔ 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
Open in Google Maps ↗

Other Names 1

Doing Business AsSouth Lake Pediatrics

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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 14, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.