GARY ALAN NISIUS (NPI# 1518995042) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518995042 |
| Entity Type | Individual |
| Full Name | GARY ALAN NISIUS |
| Credential | MD |
| Practice Address |
15655 37th Ave N Suite 100 Plymouth MN 55446-3207 |
| Practice Telephone | 7635877900 |
| Practice Fax Number | 7635877701 |
| Mailing Telephone | 7635877900 |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2020-10-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 41693 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 940521600 | 05 |
| Street Address |
15655 37TH AVE N SUITE 100 |
| City | PLYMOUTH |
| State | MN |
| Zip Code | 55446-3207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083681845 | Mancel Talcott Mitchell IIi | Family Medicine | 15655 37th Ave N, Suite 100, Plymouth, MN 55446 | 2006-03-01 |
| 1235501412 | Gwenda Lyn Hill | Dietitian, Registered | 15655 37th Ave N, Suite 100, Plymouth, MN 55446 | 2015-10-27 |
| 1083893705 | Cristen Jayne Singer | Nurse Practitioner | 15655 37th Ave N, Suite 100, Plymouth, MN 55446 | 2007-10-30 |
| 1598795155 | Thomas T Swan | Family Medicine | 15655 37th Ave N, Suite 100, Plymouth, MN 55446 | 2006-07-03 |
| 1467481994 | Amy Kay Bostic | Physician Assistant | 15655 37th Ave N, Suite 100, Plymouth, MN 55446 | 2006-06-30 |
| 1740218221 | Daniel Steven Cohan | Family Medicine | 15655 37th Ave N, Suite 100, Plymouth, MN 55446-3207 | 2006-06-30 |
| 1336177963 | Matthew S Barnes | Family Medicine | 15655 37th Ave N, Suite 100, Plymouth, MN 55446 | 2006-06-30 |
| 1396781241 | Pamela S Jaworski | Family Medicine | 15655 37th Ave N, Suite 100, Plymouth, MN 55446-3207 | 2006-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114552379 | Molly M Mahoney | Pharmacist | 4110 Juneau Lane N, Plymouth, MN 55446 | 2020-03-09 |
| 1073064804 | Owen Payne Kusick | Student in an Organized Health Care Education/Training Program | 16717 49th Pl N, Plymouth, MN 55446 | 2016-10-17 |
| 1043696214 | Kari Shoemaker | Speech-Language Pathologist | 5855 Cheshire Parkway, Plymouth, MN 55446 | 2015-08-10 |
| 1902206899 | Kathleen E Steensma | Nurse Practitioner | 15700 37th Ave N. #110, Plymouth, MN 55446 | 2014-08-27 |
| 1851715163 | Group Health Plan Inc | Clinic/Center | 5000 Fernbrook Ln N, Plymouth, MN 55446 | 2014-02-06 |
| 1588903009 | Laura Davidson | Physician Assistant | 3365 Plymouth Blvd., Suite 110, Plymouth, MN 55446 | 2013-02-04 |
| 1366680688 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 6025 Shenandoah Ln N, Plymouth, MN 55446 | 2009-01-23 |
| 1205046646 | Merida A Miller | Obstetrics & Gynecology | 4155 Cty Rd 101 N, Plymouth, MN 55446 | 2007-05-23 |
| 1376684746 | West Metro Ophthalmology, Pa | Ophthalmology | 15655 37th Ave N Ste 200, Plymouth, MN 55446 | 2007-02-09 |
| 1952401390 | Grand St Paul Cvs LLC | Pharmacy | 4140 Rd 101 N, Plymouth, MN 55446 | 2006-09-25 |
| Find all providers in zip 55446 | ||||
| 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 |
|---|---|---|---|---|
| 1265996219 | Housecall Physicians, Inc | Family Medicine | 31 Home Depot Drive, Suite 283, Plymouth, MA 02360 | 2019-01-24 |
| 1215445994 | Jefferson Community Health Center Inc | Family Medicine | 316 N Madison Ave, Ste 200, Plymouth, NE 68424-4110 | 2018-01-17 |
| 1124551833 | Xpress Urgent Care PC | Family Medicine | 49237 Fox Dr N, Plymouth, MI 48170-5205 | 2017-04-10 |
| 1952853525 | Ann Curoe | Family Medicine | 10835 38th Pl N, Plymouth, MN 55441-1409 | 2016-10-31 |
| 1639429558 | Carol Elizabeth Ness | Family Medicine | 1145 Shenandoah Ln N, Plymouth, MN 55447-3201 | 2012-09-18 |
| 1881953461 | Ronald Carl Skoogberg | Family Medicine | 3025 Harbor Lane, Suite 101, Plymouth, MN 55447-5141 | 2012-05-16 |
| 1093955700 | Soliman Home Visiting Physicians Pllc | Family Medicine | 12173 Chandler Dr, Plymouth, MI 48170-3193 | 2009-02-20 |
| 1457508079 | Chaitra Channappa | Family Medicine | 31 Home Depot Dr Ste 283, Plymouth, MA 02360-2669 | 2008-08-26 |
| 1730365388 | Milton Delin Westberg | Family Medicine | 1010 Wilson St, Plymouth, NC 27962-9185 | 2008-01-14 |
| 1194849398 | Michael A Martella | Family Medicine | 515 E Mill Street, Plymouth, WI 53073-1807 | 2007-03-16 |
| Find all providers in PLYMOUTH | ||||
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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.