NPIMap

Individual provider Active NPI

Mary Nesvig, MD

  • Family Medicine Physician
  • W. St. Paul, MN
National Provider Identifier
1073572038
Registry record updated Apr 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
32549 Issued in MN
Practice address
153 Cesar Chavez St
W. St. Paul, MN 55107-2226
Phone
(651) 222-1816
Fax
(651) 222-1305
NPI assigned
Mar 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2013

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 32549 MN Primary

Addresses

Primary practice location

153 Cesar Chavez St
W. St. Paul, MN 55107-2226

Mailing address

153 Cesar Chavez St
W. St. Paul, MN 55107-2226
Phone (651) 222-1816

Other identifiers 6

IdentifierTypeStateIssuer
0125623OtherMNMEDICA
NA9021006638OtherFMPREFERRED ONE
375395600MedicaidMN
105727OtherMNUCARE
HP14053OtherMNHEALTHPARTNERS
3F110NEOtherMNBCBS

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
I20040806000338 MN Practitioner - Family Practice 2769454206 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
32549MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
West Side Community Health Services, Inc. CurrentSince Sep 30, 2003 Accepting new patients
West Side Community Health Services, Inc. Current Accepting new patients

Locations

153 Cesar Chavez St
West Saint Paul, MN 55107
Phone (651) 222-1816

Ownership & related parties

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
West Side Community Health Services, Inc.Saint Paul, MN, CCN 241848 Federally qualified health center Corporate Officer
Operational/Managerial Control		 Oct 19, 1991
Oct 19, 1991
West Side Community Health Services, Inc.Saint Paul, MN, CCN 241849 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Oct 19, 1991
Oct 19, 1991
West Side Community Health Services, Inc.Saint Paul, MN, CCN 241851 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Oct 19, 1991
Oct 19, 1991
West Side Community Health Services, Inc.Saint Paul, MN, CCN 241853 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Oct 19, 1991
Oct 19, 1991
West Side Community Health Services, Inc.Saint Paul, MN, CCN 241854 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Oct 19, 1991
Oct 19, 1991
West Side Community Health Services, Inc.St Paul, MN, CCN 241843 Federally qualified health center W-2 Managing Employee Oct 19, 1991
West Side Community Health Services, Inc.Saint Paul, MN, CCN 241846 Federally qualified health center W-2 Managing Employee Oct 19, 1991
West Side Community Health Services, Inc.Saint Paul, MN, CCN 241847 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Oct 19, 1991
Oct 19, 1991

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

NPI Registry JSON

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366588800000",
    "number": "1073572038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 CESAR CHAVEZ ST",
            "city": "W. ST. PAUL",
            "state": "MN",
            "postal_code": "551072226",
            "telephone_number": "651-222-1816",
            "fax_number": "651-222-1305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 CESAR CHAVEZ ST",
            "city": "W. ST. PAUL",
            "state": "MN",
            "postal_code": "551072226",
            "telephone_number": "651-222-1816",
            "fax_number": "651-222-1305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NESVIG",
        "first_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-20",
        "last_updated": "2013-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "32549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "0125623",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "NA9021006638",
            "state": "FM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "375395600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "105727",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP14053",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "3F110NE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in W. St. Paul, MN

Sources for this page

Verify at the official NPI Registry.