NPIMap

Organization Active NPI

Park Nicollet Health Care Products

  • Durable Medical Equipment & Medical Supplies
  • St Louis Park, MN
National Provider Identifier
1033178983
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PARK NICOLLET HEALTH CARE PRODUCTS
Practice address
3850 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone
(952) 993-1330
Fax
(952) 993-0562
NPI assigned
Mar 20, 2006
Last updated
Nov 7, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
PARK NICOLLET HEALTH SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Authorized official

Name
Kristin Denise Brey
Title
Supervisor/Delegated Official
Phone
(952) 993-6832

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

3850 Park Nicollet Blvd
St Louis Park, MN 55416-2527

Mailing address

3800 Park Nicollet Blvd # Ms 61901C
St Louis Park, MN 55416-2527

Other identifiers 2

IdentifierTypeStateIssuer
2419617OtherNCPDP PROVIDER IDENTIFICATION NUMBER
364280100MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930072136 MN DME Supplier - Medical Supply Company 2365655164 Practice locations: Saint Louis Park, MN

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Park Nicollet Health Care Products3850 Park Nicollet Blvd, Saint Louis Park, MN 55416-2527(952) 993-3123 Traction Equipment|(TENS) Transcutaneous Electrical Nerve Stimulators and/or Supplies|Canes and/or Crutches|Walkers|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|Nebulizer Equipment and/or Supplies|Surgical Dressings|Lymphedema Compression Treatment Items Does not accept assignmentParticipating since Jul 1, 2002

National Provider Directory

National Provider Directory
Tax ID family
Park Nicollet Health Services10 organizations share this tax ID, including this one
Part of
Park Nicollet

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8401 Golden Valley Rd
Ste 100
Golden Valley, MN 55427
Phone (952) 993-8300

NPI Registry JSON

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1033178983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 PARK NICOLLET BLVD # MS 61901C",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 PARK NICOLLET BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162527",
            "telephone_number": "952-993-1330",
            "fax_number": "952-993-0562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK NICOLLET HEALTH CARE PRODUCTS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PARK NICOLLET HEALTH SERVICES",
        "enumeration_date": "2006-03-20",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "BREY",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "SUPERVISOR/DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "952-993-6832"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2419617",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "364280100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.