PARK NICOLLET METHODIST HOSPITAL (NPI# 1174980692) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174980692 |
| Entity Type | Organization |
| Organization Name | PARK NICOLLET METHODIST HOSPITAL |
| Other Organization Name | PARK NICOLLET SURGERY CENTER |
| Practice Address |
15800 95th Ave N Maple Grove MN 55369-4400 |
| Mailing Address |
Po Box 1488 Minneapolis MN 55480-1488 |
| Practice Telephone | 9529931440 |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2020-02-13 |
| Authorized Official Name | MRS. 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 |
|---|---|---|---|---|---|
| Y | 282N00000X | General Acute Care Hospital | Hospitals |
| Other Name | Type Code |
|---|---|
| Park Nicollet Surgery Center | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649827973 | Park Nicollet Methodist Hospital | Clinic/Center | 14050 Fairview Dr, Burnsville, MN 55337-5713 | 2019-08-21 |
| 1689112898 | Park Nicollet Methodist Hospital | Pharmacy | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2017-02-08 |
| 1245615772 | Park Nicollet Methodist Hospital | General Acute Care Hospital | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2015-07-27 |
| 1194113217 | Park Nicollet Methodist Hospital | General Acute Care Hospital | 3900 Park Nicollet Blvd, St Louis Park, MN 55416-2503 | 2014-12-23 |
| 1942585286 | Park Nicollet Methodist Hospital | General Acute Care Hospital | 3525 Monterey Dr, St Louis Park, MN 55416-5275 | 2011-10-19 |
| 1578717336 | Park Nicollet Methodist Hospital | Community Based Residential Treatment Facility, Mental Illness | 3525 Monterey Dr, St Louis Park, MN 55416-5275 | 2008-11-06 |
| 1942424742 | Park Nicollet Methodist Hospital | Pharmacy | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2007-04-12 |
| 1255478798 | Park Nicollet Methodist Hospital | Durable Medical Equipment & Medical Supplies | 6500 Excelsior Blvd, St Louis Park, MN 55426 | 2007-02-01 |
| 1083622047 | Park Nicollet Methodist Hospital | Anesthesiology | 6500 Excelsior Blvd, St Louis Park, MN 55426 | 2006-08-04 |
| 1447201421 | Park Nicollet Methodist Hospital | Home Health | 6500 Excelsior Blvd, St Louis Park, MN 55426 | 2006-05-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PARK NICOLLET METHODIST HOSPITAL | 6500 Excelsior Blvd, Saint Louis Park, MN 55426-4702 |
| Street Address |
15800 95TH AVE N |
| City | MAPLE GROVE |
| State | MN |
| Zip Code | 55369-4400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225011760 | Bernt J Helgaas | Internal Medicine | 15800 95th Ave N, Maple Grove, MN 55369-4400 | 2005-11-29 |
| 1558707455 | Jaclyn C Hawes | Physician Assistant | 15800 95th Ave N, Maple Grove, MN 55369-4400 | 2013-05-17 |
| 1346561032 | Valerie Lee Saladin | Physician Assistant | 15800 95th Ave N, Maple Grove, MN 55369-4400 | 2010-06-16 |
| 1417198839 | Jeannette A Heidlberg | Internal Medicine | 15800 95th Ave N, Maple Grove, MN 55369-4400 | 2009-03-13 |
| 1205009016 | Alisa Brooke Grismer | Pharmacist | 15800 95th Ave N, Park Nicollet, Maple Grove, MN 55369-4400 | 2008-04-12 |
| 1619096245 | Jacob Jared Sundberg | Chiropractor | 15800 95th Ave N, Maple Grove, MN 55369-4400 | 2007-03-28 |
| 1982748349 | Sonya Schober | Internal Medicine | 15800 95th Ave N, Maple Grove, MN 55369-4400 | 2007-02-19 |
| 1104962844 | Christine Suzanne Goudge Walker | Obstetrics & Gynecology | 15800 95th Ave N, Park Nicollet - Dept of Ob/gyn, Maple Grove, MN 55369-4400 | 2007-01-29 |
| 1750469219 | Jerusha Clare Brager | Physical Therapist | 15800 95th Ave N, Rehab, Maple Grove, MN 55369-4400 | 2006-11-01 |
| 1568552990 | Elizabeth G Yuhasz | Occupational Therapist | 15800 95th Ave N, Maple Grove, MN 55369-4400 | 2006-10-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376144188 | Bonnie Rose Theis | Counselor | 24 3rd Ave Ne, Unit B, Osseo, MN 55369 | 2020-11-06 |
| 1356976328 | Kirollos Samir Hanna | Pharmacist | 14500 99th Ave N, Suite 0a030, Maple Grove, MN 55369 | 2020-03-10 |
| 1396395463 | Susan Osborne | Technician | 9240 Orchid Lane, Maple Grove, MN 55369 | 2019-09-19 |
| 1710537196 | Janis Langsdale | Technician | 11070 108 Avenue North, Maple Grove, MN 55369 | 2019-09-17 |
| 1043724552 | Tracey Wahlquist | Speech-Language Pathologist | 11100 86th Ave N, Maple Grove, MN 55369 | 2017-11-20 |
| 1154860005 | Kayla Uptagrafft | Specialist/Technologist | 9555 Upland Lane Norh, Maple Grove, MN 55369 | 2017-02-13 |
| 1750823324 | Jennifer Ranallo | Social Worker | 9600 Upland Ln N Ste 110, Maple Grove, MN 55369 | 2016-11-13 |
| 1558723999 | Debra Grace Boersma | Advanced Practice Midwife | 9825 Hospital Dr#205, Maple Grove, MN 55369 | 2016-03-24 |
| 1396129433 | Maple Grove Smiles Dentistry, PC | Dentist | 12775 Elm Creek Blvd N, Maple Grove, MN 55369 | 2015-07-18 |
| 1558755900 | Krista Newman | Counselor | 24 3rd St Nw, Unit B, Osseo, MN 55369 | 2015-03-24 |
| Find all providers in zip 55369 | ||||
| Taxonomy Code | 282N00000X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790092815 | Park Nicollet Clinic | General Acute Care Hospital | 9827 Maple Grove Pkwy N, Maple Grove, MN 55369-4491 | 2010-09-10 |
| 1225272552 | Maple Grove Hospital Corporation | General Acute Care Hospital | 9875 Hospital Drive, Maple Grove, MN 55369 | 2009-04-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811372360 | Karin Costin | General Acute Care Hospital | 803 E 28th St, Minneapolis, MN 55407 | 2015-07-27 |
| 1619317070 | Allegheny General Hospital | General Acute Care Hospital | 724 4th St Sw, Rochester, MN 55902-2913 | 2013-07-01 |
| 1003196361 | Fairview | General Acute Care Hospital | 21282 Inspiration Ct, Lakeville, MN 55044-6027 | 2011-08-18 |
| 1356652481 | Spectrum Health | General Acute Care Hospital | 25850 Brolin Beach Rd, Detroit Lakes, MN 56501-7978 | 2010-06-23 |
| 1093960742 | Fairview Health Services | General Acute Care Hospital | 13017 Lakeview Dr, Burnsville, MN 55337-3857 | 2008-11-22 |
| 1144477282 | Allina Home Care Hospice and Palliative Care | General Acute Care Hospital | 1055 Westgate Dr. Suite 100, St. Paul, MN 55114-1451 | 2008-08-20 |
| 1104029388 | Shannon Carl Nelson | General Acute Care Hospital | Highway 1 Box 497, Red Lake, MN 56671 | 2007-06-06 |
| 1356559983 | Rtgmedical | General Acute Care Hospital | 2186 Baneberry Way W, Chanhassen, MN 55317 | 2007-05-18 |
| 1730232307 | Jack Ramon Lees | General Acute Care Hospital | 2146 Lemay Lake Dr, Mendota Heights, MN 55120-1183 | 2007-01-18 |
| 1245349257 | Russell Vincent Luepker | General Acute Care Hospital | 1300 S 2nd St, Suite 300, Minneapolis, MN 55454-1075 | 2006-08-30 |
| Find all providers with the same taxonomy | ||||
| City | MAPLE GROVE |
| Zip Code | 55369 |
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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.