NPIMap

Individual provider Active NPI

Patrick Thaddeus McCarthy

  • Emergency Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1053706622
Registry record updated Mar 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
63093 Issued in MN
Practice address
701 Park Ave
Minneapolis, MN 55415-1623
Phone
(612) 873-3000
NPI assigned
Apr 1, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 63093 MN Primary

Addresses

Primary practice location

701 Park Ave
Minneapolis, MN 55415-1623

Mailing address

2919 Chestnut Ave
Minneapolis, MN 55405-1739

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
I20180124002474 MN Practitioner - Emergency Medicine 4082913124 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Minnesota Medical School, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Suburban Emergency Associates PAGroup PAC ID 8325950975, 20 clinicians

Practice addresses (Care Compare)

1455 Saint Francis Ave
Shakopee, MN 55379-3374
Phone (952) 428-3000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
27127MNMDClinical Social Worker
63093MNMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Glencoe Regional Health Services CurrentSince Jan 5, 2018 Accepting new patients
Glencoe Regional Health Services CurrentSince Jan 5, 2018 Accepting new patients
Suburban Emergency Associates, P.a. Emergency Medicine CurrentSince Jan 1, 2019 Accepting new patients
Grand Itasca Clinic and Hospital CurrentSince Jan 15, 2018 Accepting new patients
Fairview Express Care CurrentSince Jun 3, 2018 Accepting new patients
Fairview Health Services Current Accepting new patients
Cuyuna Regional Medical Center Current Accepting new patients
Cuyuna Regional Medical Center CurrentSince Apr 1, 2018 Accepting new patients
Cuyuna Regional Medical Center CurrentSince Apr 1, 2018 Accepting new patients
Grand Itasca Clinic and Hospital CurrentSince Jan 15, 2018 Accepting new patients
Fairview Health Services CurrentSince Jun 3, 2018 Accepting new patients

Locations

320 E Main St
Crosby, MN 56441
Phone (218) 546-7000

1805 Hennepin Ave N
Glencoe, MN 55336
Phone (320) 864-3121

1601 Golf Course Rd
Grand Rapids, MN 55744
Phone (218) 326-3401

111 SE 3rd St
Grand Rapids, MN 55744
Phone (218) 326-3401

2450 Riverside Ave
Ste F140
Minneapolis, MN 55454
Phone (651) 464-4847

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

1455 Saint Francis Ave
Shakopee, MN 55379
Phone (952) 403-2200

Organizations & group practices 12

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 2

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": "1427846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520985600000",
    "number": "1053706622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2919 CHESTNUT AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554051739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151623",
            "telephone_number": "612-873-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCARTHY",
        "first_name": "PATRICK",
        "middle_name": "THADDEUS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-01",
        "last_updated": "2018-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "63093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.