NPIMap

Individual provider Active NPI

Jeffrey J Shultz

  • Cardiovascular Disease Physician
  • St Louis Park, MN
National Provider Identifier
1003893520
Registry record updated Oct 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
34079 Issued in MN
Practice address
6500 Excelsior Blvd
Park Nicollet Clinic - Heart & Vascular Center
St Louis Park, MN 55426-4702
Phone
(952) 993-3246
Fax
(952) 993-3010
NPI assigned
Dec 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 34079 MN Primary

Addresses

Primary practice location

6500 Excelsior Blvd
Park Nicollet Clinic - Heart & Vascular Center
St Louis Park, MN 55426-4702

Mailing address

6465 Wayzata Blvd
Ste 315
St Louis Park, MN 55426-1728
Phone (952) 993-7169

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050614000896 MN Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology) 4587563655 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiac Electrophysiology
Education
University of Southern California Keck School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-3123

Hospital & facility affiliations

  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053
  • Hutchinson Health Hospital, Hutchinson, MN, CCN 240187
  • Olivia Hospital & Clinic Hospital, Olivia, MN, CCN 241306

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair60

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
34079MNMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Jul 11, 2005 Accepting new patients
Hutchinson Health CurrentSince Jan 1, 2019 Accepting new patients
Tria Orthopaedic Center LLC CurrentSince Dec 30, 2020 Accepting new patients
Tria Orthopaedic Center LLC CurrentSince Dec 30, 2020 Accepting new patients
Park Nicollet Clinic CurrentSince Jul 11, 2005 Accepting new patients

Locations

1029 Highway 15 S
Hutchinson, MN 55350
Phone (320) 275-3358

8100 Northland Dr
Minneapolis, MN 55431
Phone (952) 831-1626

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

6500 Excelsior Blvd
St Louis Park, MN 55426
Phone (952) 993-3246

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317772800000",
    "number": "1003893520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6465 WAYZATA BLVD",
            "address_2": "STE 315",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261728",
            "telephone_number": "952-993-7169",
            "fax_number": "952-993-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 EXCELSIOR BLVD",
            "address_2": "PARK NICOLLET CLINIC - HEART & VASCULAR CENTER",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264702",
            "telephone_number": "952-993-3246",
            "fax_number": "952-993-3010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHULTZ",
        "first_name": "JEFFREY",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-27",
        "last_updated": "2011-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MN",
            "license": "34079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.