NPIMap

Individual provider Active NPI

Mark Westholder

  • Family Medicine Physician
  • Shakopee, MN
National Provider Identifier
1023095775
Registry record updated Mar 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
40836 Issued in MN
Practice address
1415 Saint Francis Ave
Shakopee, MN 55379-3374
Phone
(952) 993-7800
NPI assigned
Dec 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 40836 MN Primary

Addresses

Primary practice location

1415 Saint Francis Ave
Shakopee, MN 55379-3374

Mailing address

3800 Park Nicollet Blvd
Credentialing
Minneapolis, MN 55416-2527

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
I20050714000520 MN Practitioner - Family Practice 8527094176 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

1415 Saint Francis Ave
Shakopee, MN 55379-3374
Phone (952) 993-7750

4670 Park Nicollet Ave SE
Prior Lake, MN 55372-4119
Phone (952) 993-7750

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

Hospital & facility affiliations

  • Allina Health Home Health Home health agency, Minneapolis, MN, CCN 248091
  • Adara Home Health Inc Home health agency, Buffalo, MN, CCN 248056
  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053
  • St Francis Regional Medical Center Hospital, Shakopee, MN, CCN 240104

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
40836MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Family Medicine CurrentSince Mar 1, 2003 Accepting new patients
Park Nicollet Clinic Family Medicine CurrentSince Mar 1, 2003 Accepting new patients

Locations

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

1415 Saint Francis Ave
Shakopee, MN 55379
Phone (952) 993-7750

3800 Park Nicollet Blvd
St Louis Park, MN 55416
Phone (952) 993-1000

Interoperability endpoints

  • Direct secure messaging: mwestholder156791@direct.healthpartners.com

Organizations & group practices 2

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 11

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": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331164800000",
    "number": "1023095775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 PARK NICOLLET BLVD",
            "address_2": "CREDENTIALING",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554162527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 SAINT FRANCIS AVE",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553793374",
            "telephone_number": "952-993-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WESTHOLDER",
        "first_name": "MARK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-23",
        "last_updated": "2012-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "40836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shakopee, MN

Sources for this page

Verify at the official NPI Registry.