Active NPI
Holley Gullickson
- Nurse Practitioner
- Robbinsdale, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- R1551082
- Practice address
- 3366 Oakdale Ave N
Suite 605
Robbinsdale, MN 55422-2948 - Phone
- (763) 520-2940
- NPI assigned
- Aug 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R1551082 | MN | Primary |
Addresses
Primary practice location
3366 Oakdale Ave N
Suite 605
Robbinsdale, MN 55422-2948
Mailing address
3366 Oakdale Ave N
Suite 605
Robbinsdale, MN 55422-2948
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060208000845 | MN | Practitioner - Nurse Practitioner | 0345255535 | Reassigns benefits to 5 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Curana Health of Minnesota PLLCLifespark Medical Group PA
Practice addresses (Care Compare)
5123 W 98TH St
Suite 2082
Minneapolis, MN 55437-2040
Phone (737) 226-6700
5320 W 23Rd St
Suite 130
St Louis Park, MN 55416-1670
Phone (952) 345-3213
Hospital & facility affiliations
- Lifespark Home Health
- M Health Fairview University of MN Medical Center
- Abbott Northwestern Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.25 of 100
- Quality
- 60.43
- Promoting interoperability
- 83
- Improvement activities
- 40
- Cost
- 79.28
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R1551082 | MN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Respiratory Consultants PA | Current | Accepting new patients | |
| CH Specialty Services MN PC | Current | Accepting new patients | |
| Spark Medical Providers PA | Current | Accepting new patients | |
| Lifespark Medical Group, PA | Current | Accepting new patients | |
| Curana Health of Minnesota PLLC | Nurse Practitioner | Current | Accepting new patients |
Locations
9875 Hospital Dr
Maple Grove, MN 55369
Phone (763) 581-1000
5123 W 98th St
Minneapolis, MN 55437
Phone (312) 961-4490
2800 Campus Dr
Ste 10
Plymouth, MN 55441
Phone (763) 398-4400
3366 Oakdale Ave N
Ste 605
Robbinsdale, MN 55422
Phone (612) 561-5986
3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048
5320 W 23rd St
Ste 130
St Louis Park, MN 55416
Phone (952) 345-3213
Interoperability endpoints
- hgullickson921@direct.northmemorial.com
- holley.gullickson.1@15699.direct.athenahealth.com
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
- holley.gullickson.1@17901.direct.athenahealth.com
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.
-
- Internal Medicine Physician
- Minneapolis, MN
- NPI 1083365084
MN, Nurse Practitioner
-
- Geriatric Medicine (Family Medicine) Physician
- St Louis Park, MN
- NPI 1427551746
MN
-
- Geriatric Medicine (Internal Medicine) Physician
- St Louis Park, MN
- NPI 1760374680
MN
Hospital & facility affiliations 27
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Obesity Medicine (Family Medicine) Physician
- Minneapolis, MN
- NPI 1154684835
Hospital
-
- Physical Medicine & Rehabilitation Physician
- Minneapolis, MN
- NPI 1275577215
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023025517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3366 OAKDALE AVE N",
"address_2": "SUITE 605",
"city": "ROBBINSDALE",
"state": "MN",
"postal_code": "554222948"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3366 OAKDALE AVE N",
"address_2": "SUITE 605",
"city": "ROBBINSDALE",
"state": "MN",
"postal_code": "554222948",
"telephone_number": "763-520-2940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GULLICKSON",
"first_name": "HOLLEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MN",
"license": "R1551082",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Robbinsdale, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.