Active NPI
Mark A Nammacher, MD
- Pediatrics Physician
- St Louis Park, MN
National Provider Identifier
1104880905
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 20132
- Practice address
- 6600 Excelsior Blvd
131
St Louis Park, MN 55426-4744 - Phone
- (952) 401-8290
- Fax
- (952) 401-8243
- NPI assigned
- Apr 17, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 20132 | MN | Primary |
Addresses
Primary practice location
6600 Excelsior Blvd
131
St Louis Park, MN 55426-4744
Mailing address
4711 Cedarwood Rd
Minneapolis, MN 55416-1970
Phone (952) 929-7683
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HP51758 | Other | MN | HEALTH PARTNERS |
| 145J4NA | Other | MN | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20132 | MN | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1104880905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4711 CEDARWOOD RD",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554161970",
"telephone_number": "952-929-7683"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6600 EXCELSIOR BLVD",
"address_2": "131",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554264744",
"telephone_number": "952-401-8290",
"fax_number": "952-401-8243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAMMACHER",
"first_name": "MARK",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-17",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "20132",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP51758",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "145J4NA",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.