NPIMap

Individual provider Active NPI

Justin Michael Penny, D.O.

  • Family Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1023541604
Registry record updated Sep 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
64166 Issued in MN
Practice address
1221 W Lake St Ste 201
Minneapolis, MN 55408-3565
Phone
(612) 824-1772
Fax
(612) 821-4799
NPI assigned
Apr 10, 2017
Last updated
Sep 4, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

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 64166 MN Primary

Addresses

Primary practice location

1221 W Lake St Ste 201
Minneapolis, MN 55408-3565

Mailing address

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-9000

Other practice location 1

2020 E 28th St Ste 104
Minneapolis, MN 55407-1453
Phone (612) 343-7158

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
I20200622001771 MN Practitioner - Family Practice 5496025124 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

1221 W Lake St
Suite 201
Minneapolis, MN 55408-3565
Phone (612) 824-1772

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Clinics CurrentSince Nov 1, 2020 Accepting new patients
Fairview Express Care CurrentSince Jul 19, 2020 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Nov 1, 2020 Accepting new patients
Allina Health System Family Medicine Current Accepting new patients
Fairview Express Care CurrentSince Aug 10, 2020 Accepting new patients
Allina Health System Family Medicine CurrentSince Apr 28, 2025 Accepting new patients
Fairview Health Services CurrentSince Jul 19, 2020 Accepting new patients
Fairview Express Care CurrentSince Aug 10, 2020 Accepting new patients
Allina Health System CurrentSince Apr 28, 2025 Accepting new patients
Allina Health System Family Medicine Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

1221 W Lake St
Ste 201
Minneapolis, MN 55408
Phone (612) 270-9652

2020 E 28th St
Minneapolis, MN 55407
Phone (612) 333-0770

2020 E 28th St
Ste 104
Minneapolis, MN 55407
Phone (612) 333-0770

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

Interoperability endpoints

  • Direct secure messaging: jpenny403192@fairview.direct-ci.com
  • Direct secure messaging: jpenny715954@excellian.direct.allina.com

Organizations & group practices 14

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

View all 14

Hospital & facility affiliations 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756944000000",
    "number": "1023541604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 W LAKE ST STE 201",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554083565",
            "telephone_number": "612-824-1772",
            "fax_number": "612-821-4799"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2020 E 28th St Ste 104",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554071453",
            "country_code": "US",
            "telephone_number": "612-343-7158",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENNY",
        "first_name": "JUSTIN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-10",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "64166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.