Individual provider Active NPI

Cassandra McMillan Jones, M.D.

  • Family Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1104050186
Registry record updated Jun 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
53587 Issued in MN
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

Updated by the provider on Jun 27, 2018

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 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 Former name

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110314001071 MN Practitioner - Family Practice 1456533348 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53587MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emily Program P C CurrentSince Sep 10, 2018 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.

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

Verify at the official NPI Registry.