NPIMap

Individual provider Active NPI

Mark K Yamaguchi, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Woodbury, MN
National Provider Identifier
1033313580
Registry record updated Apr 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
52910 Issued in MN
Practice address
155 Radio Dr
Woodbury, MN 55125-2619
Phone
(952) 831-8742
Fax
(952) 977-3459
NPI assigned
Jun 11, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X 52910 MN Primary

Addresses

Primary practice location

155 Radio Dr
Woodbury, MN 55125-2619

Mailing address

8170 33Rd Ave S # Ms 21110Q
Bloomington, MN 55425-4516

Other practice location 1

1950 Curve Crest Blvd W
Suite 100
Stillwater, MN 55082-5078
Phone (651) 430-3800

Other practice location 2

405 Stageline Rd
Hudson, WI 54016-1793
Phone (715) 531-6700

Other practice location 3

295 Phalen Blvd
Saint Paul, MN 55130-2400
Phone (651) 495-6200

Other identifiers 4

IdentifierTypeStateIssuer
1033313580MedicaidWI
000000614543OtherINANTHEM PROVIDER NUMBER
1033313580MedicaidMN
200863980MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100824001312 MN Practitioner - Interventional Pain ManagementPractitioner - AnesthesiologyPractitioner - Pain Management 6305946773 Reassigns benefits to 3 organizations
I20220509000546 WI Practitioner - Interventional Pain Management 6305946773 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional Pain ManagementAlso: Anesthesiology, Pain Management
Education
Creighton University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tria Orthopaedic Center LLCGroup PAC ID 3173570561, 504 clinicians

Practice addresses (Care Compare)

155 Radio Dr
Woodbury, MN 55125-2619
Phone (952) 831-8742

403 Stageline Rd
Hudson, WI 54016-7848
Phone (952) 831-8742

405 Stageline Rd
Hudson, WI 54016-7848
Phone (952) 831-8742

411 Stageline Rd
Hudson, WI 54016-7848
Phone (952) 831-8742

8100 Northland Dr
Bloomington, MN 55431-4800
Phone (952) 831-8742

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services CurrentSince Jan 1, 2013 Accepting new patients
Group Health, Inc. CurrentSince May 2, 2022 Accepting new patients
Fairview Clinics CurrentSince Jan 1, 2013 Accepting new patients
Group Health, Inc. CurrentSince May 2, 2022 Accepting new patients
Fairview Health Services Current Accepting new patients
Group Health, Inc. CurrentSince May 2, 2022 Accepting new patients
Tria Orthopaedic Center LLC CurrentSince May 2, 2022 Accepting new patients
St. Joseph Primary Care, LLC Past Accepting new patients
Wishard Anesthesia Group, LLC Past Accepting new patients

Locations

9875 Hospital Dr
Maple Grove, MN 55369
Phone (763) 581-1000

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

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

7373 France Ave S
Ste 408
Minneapolis, MN 55435
Phone (952) 831-8228

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

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

295 Phalen Blvd
Saint Paul, MN 55130
Phone (651) 254-3200

155 Radio Dr
Woodbury, MN 55125
Phone (952) 883-6212

405 Stageline Rd
Hudson, WI 54016
Phone (715) 531-6000

744 E Louisiana St
St Croix Fls, WI 54024
Phone (651) 772-6251

Organizations & group practices 10

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.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649808000000",
    "number": "1033313580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 RADIO DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252619",
            "telephone_number": "952-831-8742",
            "fax_number": "952-977-3459"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1950 Curve Crest Blvd W",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Stillwater",
            "state": "MN",
            "postal_code": "550825078",
            "country_code": "US",
            "telephone_number": "651-430-3800",
            "fax_number": "651-430-3827",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "405 Stageline Rd",
            "address_purpose": "LOCATION",
            "city": "Hudson",
            "state": "WI",
            "postal_code": "540161793",
            "country_code": "US",
            "telephone_number": "715-531-6700",
            "fax_number": "715-531-6801",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "295 Phalen Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551302400",
            "country_code": "US",
            "telephone_number": "651-495-6200",
            "fax_number": "952-883-9677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YAMAGUCHI",
        "first_name": "MARK",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-11",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "MN",
            "license": "52910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033313580",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000614543",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033313580",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200863980",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

Verify at the official NPI Registry.