NPIMap

Individual provider Active NPI

Bradley Eugene Nelson, CNP

  • Nurse Practitioner
  • Brooklyn Center, MN
National Provider Identifier
1083008924
Registry record updated May 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
8806 Issued in MN
Practice address
6200 Shingle Creek Pkwy
Ste 250
Brooklyn Center, MN 55430-2107
Phone
(763) 544-0696
Fax
(763) 544-0696
NPI assigned
Mar 27, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 10, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 671723 NY
Gerontology Nurse Practitioner 363LG0600X F307678 NY
Nurse Practitioner 363L00000X 8806 MN Primary

Addresses

Primary practice location

6200 Shingle Creek Pkwy
Ste 250
Brooklyn Center, MN 55430-2107

Mailing address

6200 Shingle Creek Pkwy
Ste 250
Brooklyn Center, MN 55430-2107
Phone (763) 544-0696

Other practice location 1

622 W 168th St
New York, NY 10032-3720
Phone (212) 305-3273

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, MN2 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
I20161031001529 NY Practitioner - Nurse Practitioner 9234417973 Reassigns benefits to 2 organizations
I20220303000116 MN Practitioner - Nurse Practitioner 9234417973 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kidney Specialists of Minnesota, PAGroup PAC ID 5092616029, 33 clinicians

Practice addresses (Care Compare)

6200 Shingle Creek Pkwy
Suite 250
Brooklyn Center, MN 55430-2107
Phone (763) 544-0696

Hospital & facility affiliations

  • Abbott Northwestern Hospital Hospital, Minneapolis, MN, CCN 240057
  • M Health Fairview University of MN Medical Center Hospital, Minneapolis, MN, CCN 240080
  • Mercy Hospital Hospital, Coon Rapids, MN, CCN 240115
  • Ridgeview Medical Center Hospital, Waconia, MN, CCN 240056
  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
8806MNMDGeneral Practice Dentistry
671723NYMDRegistered Nurse
F307678NYMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Memorial Health Care CurrentSince May 7, 2023 Accepting new patients
Trustees of Columbia University in the City of New York Nurse Practitioner Current Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Jan 1, 2019 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Sep 19, 2016 Accepting new patients
Kidney Specialists of Minnesota, PA CurrentSince Jan 1, 2022 Accepting new patients
North Memorial Health Care Current Accepting new patients
North Memorial Health Care CurrentSince May 7, 2023 Accepting new patients
Ilbnc, P.a. PastSince Jan 1, 2022 Accepting new patients

Locations

6200 Shingle Creek Pkwy
Ste 260
Minneapolis, MN 55430
Phone (763) 544-0696

6200 Shingle Creek Pkwy
Ste 250
Minneapolis, MN 55430
Phone (612) 823-8001

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

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

630 W 168th St
New York, NY 10032
Phone (212) 305-1948

630 W 168th St
#4
New York, NY 10032
Phone (212) 305-6387

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • Direct secure messaging: bnelson36012@direct.acumenmd.com

Organizations & group practices 8

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 42

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

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1427414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1083008924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 SHINGLE CREEK PKWY",
            "address_2": "STE 250",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302107",
            "telephone_number": "763-544-0696",
            "fax_number": "763-544-0696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 SHINGLE CREEK PKWY",
            "address_2": "STE 250",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302107",
            "telephone_number": "763-544-0696",
            "fax_number": "763-544-0696"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "622 W 168th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100323720",
            "country_code": "US",
            "telephone_number": "212-305-3273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "BRADLEY",
        "middle_name": "EUGENE",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-03-27",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "671723",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NY",
            "license": "F307678",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "8806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn Center, MN

Sources for this page

Verify at the official NPI Registry.