Active NPI
Cassandra McMillan Jones, M.D.
- Family Medicine Physician
- Minneapolis, MN
National Provider Identifier
1104050186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 53587
- Practice address
- 1020 W Broadway Ave
Minneapolis, MN 55411 - Phone
- (612) 302-8200
- Fax
- (612) 302-8275
- NPI assigned
- May 6, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 53587 | MN | Primary |
Addresses
Primary practice location
1020 W Broadway Ave
Minneapolis, MN 55411
Mailing address
1020 W Broadway Ave
Minneapolis, MN 55411-2504
Phone (612) 302-8200
Other names 1
- Dr. Cassandra Lee McMillan
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53587 | MN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emily Program P C | Current | Accepting new patients | |
| The Emily Program | Past | Accepting new patients | |
| Emily Program PC | Past | Accepting new patients |
Locations
2265 Como Ave
Saint Paul, MN 55108
5354 Parkdale Dr
Fl 2
St Louis Park, MN 55416
Phone 6516455323 ext. 1480
Organizations & group practices 3
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- St Paul, MN
- NPI 1528165065
-
- Mental Illness Community Based Residential Treatment Facility
- Saint Paul, MN
- NPI 1649309246
-
- Community/Behavioral Health Agency
- Seattle, WA
- NPI 1154696698
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530057600000",
"number": "1104050186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1020 W BROADWAY AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554112504",
"telephone_number": "612-302-8200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1020 W BROADWAY AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55411",
"telephone_number": "612-302-8200",
"fax_number": "612-302-8275"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JONES",
"first_name": "CASSANDRA",
"middle_name": "MCMILLAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-06",
"last_updated": "2018-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "53587",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CASSANDRA",
"last_name": "MCMILLAN",
"middle_name": "LEE",
"prefix": "DR.",
"credential": "M.D.",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.