PARK NICOLLET CLINIC (NPI# 1063897593) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063897593 |
| Entity Type | Organization |
| Organization Name | PARK NICOLLET CLINIC |
| Other Organization Name | PARK NICOLLET CLINIC EPISODIC BUNDLE |
| Practice Address |
3800 Park Nicollet Blvd St Louis Park MN 55416-2527 |
| Mailing Address |
3800 Park Nicollet Blvd Attention: Business Services St Louis Park MN 55416-2527 |
| Practice Telephone | 9529933123 |
| Practice Fax Number | 9529932770 |
| Mailing Telephone | 9529931000 |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2019-09-09 |
| Authorized Official Name | MS. TRICIA L DEGE (SR VICE PRESIDENT, CFO) |
| Authorized Official Telephone | 9528835121 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Park Nicollet Clinic Episodic Bundle | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659741924 | Park Nicollet Clinic | Internal Medicine | 3800 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2015-09-30 |
| 1447668678 | Park Nicollet Clinic | Pediatrics | 7000 Target Pkwy N, Brooklyn Park, MN 55445-4301 | 2014-07-31 |
| 1912315144 | Park Nicollet Clinic | Chiropractor | 1000 Nicollet Mall, Tps 260, Minneapolis, MN 55403-2542 | 2014-07-31 |
| 1790092815 | Park Nicollet Clinic | General Acute Care Hospital | 9827 Maple Grove Pkwy N, Maple Grove, MN 55369-4491 | 2010-09-10 |
| 1780621904 | Park Nicollet Clinic | Clinic/Center | 3800 Park Nicollet Blvd, St Louis Park, MN 55416 | 2006-05-31 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PARK NICOLLET CLINIC | 3800 Pk Nicollet Blvd, Minneapolis, MN 55416-2527 |
| Street Address |
3800 PARK NICOLLET BLVD |
| City | ST LOUIS PARK |
| State | MN |
| Zip Code | 55416-2527 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861497745 | Mary C Fields | Psychiatry & Neurology | 3800 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2005-06-16 |
| 1316552383 | Emily Elizabeth Morimoto | Psychologist | 3800 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2020-09-15 |
| 1245862846 | Caara Hirsch Leintz | Physician Assistant | 3800 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2020-02-11 |
| 1477102770 | Kyja Foster | Counselor | 3800 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2019-09-09 |
| 1750938411 | Abigale Jayne Harris | Social Worker | 3800 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2019-08-19 |
| 1912552076 | Michael Patrick Miller | Dietitian, Registered | 3800 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2019-08-06 |
| 1083277743 | Jessica B Arndt | Social Worker | 3800 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2019-04-18 |
| 1043785157 | Jerry L Juhl | Physical Therapist | 3800 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2018-10-05 |
| 1437624558 | Chandler Elise Domian Ommen | Occupational Therapist | 3800 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2018-10-04 |
| 1861977472 | Sarah Ruth Tupper | Nurse Practitioner | 3800 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2018-09-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639711492 | Ismahan Abdirahman Mohamed | Psychologist | 4236 Parkglen Rd, St Louis Park, MN 55416 | 2019-10-14 |
| 1598307860 | Ayman Abulaziz Mohamed | Counselor | 4326 Park Glen Rd, St Louis Park, MN 55416 | 2019-10-08 |
| 1831758929 | Ally Group Homes LLC | Assisted Living Facility | 2944 Princeton Ave South, Saint Louis Park, MN 55416 | 2019-06-11 |
| 1609371525 | Heather Margaret Flatgard | Chiropractor | 5407 Excelsior Blvd Ste D, St Louis Park, MN 55416 | 2018-03-25 |
| 1942702394 | Polaris Pharmacy Services of Minnesota, LLC | Pharmacy | 4220 Park Glen Road, St. Louis Park, MN 55416 | 2018-03-01 |
| 1316469760 | Evert Ray Boyd | Psychologist | 3200 Highway 100 S., Groves Academy, St Louis Park, MN 55416 | 2017-07-07 |
| 1861941684 | Amanda Marie Tapper | Marriage & Family Therapist | 5407 Excelsior Blvd, Suite B, St Louis Park, MN 55416 | 2016-09-22 |
| 1326410416 | Clear Health Chiropractic LLC | Chiropractor | 5614 W 36th St, St. Louis Park, MN 55416 | 2015-10-28 |
| 1568897833 | Kay Elizabeth Lichtenberger | Physical Therapist | 4415 W 36.5 St, St. Louis Park, MN 55416 | 2013-09-05 |
| 1710221510 | Aaron Christopher Oppelt | Counselor | 1665 Utica Ave South - Suite 100, Saint Louis Park, MN 55416 | 2012-11-16 |
| Find all providers in zip 55416 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225065279 | Kristin Kay Christiansen | Family Medicine | 6600 Excelsior Blvd Ste 181, St Louis Park, MN 55426-4747 | 2006-06-26 |
| 1720040900 | Himanshu S Sharma | Family Medicine | 6600 Excelsior Blvd Ste 160, St Louis Park, MN 55426-4713 | 2006-04-04 |
| 1174500995 | Thomas A Schmidt | Family Medicine | Methodist Hospital Administration, 6500 Excelsior Blvd, St Louis Park, MN 55426 | 2005-12-22 |
| 1275519563 | Deborah Mangham | Family Medicine | 3525 Monterey Dr, St Louis Park, MN 55416-5275 | 2005-12-19 |
| 1043295587 | Michael Dukinfield | Family Medicine | 6600 Excelsior Blvd, Suite 160, St Louis Park, MN 55426-4744 | 2005-12-07 |
| 1669471900 | Michael A Dole | Family Medicine | 3408 Dakota Ave S, St Louis Park, MN 55416-2312 | 2005-07-19 |
| 1386135622 | Jessica Jane Miller | Family Medicine | 6600 Excelsior Blvd Ste 160, St Louis Park, MN 55426-4713 | 2018-05-22 |
| 1295180628 | Isaac Zoller | Family Medicine | 6600 Excelsior Blvd Ste 160, St Louis Park, MN 55426-4713 | 2016-05-04 |
| 1609259688 | Maria Teresa Gonzalez Bolanos | Family Medicine | 3850 Park Nicollet Blvd, St Louis Park, MN 55416-2527 | 2015-07-08 |
| 1538540109 | Elina Lipovskiy | Family Medicine | 3850 Park Nicollet Blvd, St Louis Park, MN 55416 | 2015-06-09 |
| Find all providers in ST LOUIS PARK | ||||
| City | ST LOUIS PARK |
| Zip Code | 55416 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.