NPIMap

Organization Active NPI

Minuteclinic Primary Care Minnesota PLLC

  • Family Nurse Practitioner
  • Eagan, MN
National Provider Identifier
1104632801
Registry record updated Mar 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
MINUTECLINIC PRIMARY CARE MINNESOTA PLLC
Practice address
4241 Johnny Cake Ridge Rd
Eagan, MN 55122-2235
Phone
(866) 389-2727
NPI assigned
Dec 6, 2024
Last updated
Mar 24, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
PRIMARY CARE PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 24, 2026

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

Authorized official

Name
Deborah Pincince
Title
Administrator
Phone
(866) 389-2727

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

4241 Johnny Cake Ridge Rd
Eagan, MN 55122-2235

Mailing address

PO Box 772
Woonsocket, RI 02895-0784

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250327001623 MN Part B Supplier - Clinic/Group Practice 2163945460 Receives reassigned benefits from 76 practitioners
Practice locations: Minneapolis, MN; Minnetonka, MN; New Hope, MN; Otsego, MN; Plymouth, MN; Richfield, MN; Roseville, MN; Saint Cloud, MN…

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2316666Minuteclinic Primary Care-Minnesota, PLLC #278304241 Johnny Cake Ridge Rd, Eagan, MN 55122Certificate of waiverJan 8, 2027

National Provider Directory

National Provider Directory
Part of
Primary Care PLLC

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2357 108th Ln NE
Blaine, MN 55449
Phone (763) 780-0776

4241 Johnny Cake Ridge Rd
Eagan, MN 55122
Phone (651) 688-7041

1010 W Lake St
Minneapolis, MN 55408
Phone (612) 822-1297

875 E Main St
Waconia, MN 55387
Phone (952) 442-9333

Practitioners & affiliated clinicians

Practitioners 77

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 77

NPI Registry JSON

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

{
    "created_epoch": "1733443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774310400000",
    "number": "1104632801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 772",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028950784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4241 JOHNNY CAKE RIDGE RD",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551222235",
            "telephone_number": "866-389-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINUTECLINIC PRIMARY CARE MINNESOTA PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMARY CARE PLLC",
        "enumeration_date": "2024-12-06",
        "last_updated": "2026-03-24",
        "certification_date": "2026-03-24",
        "status": "A",
        "authorized_official_last_name": "PINCINCE",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "866-389-2727"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.