Active NPI
Michelle J Poppen, RD
- Registered Dietitian
- Worthington, MN
National Provider Identifier
1114143948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1173
- Practice address
- 1018 6TH Ave
Worthington, MN 56187-2202 - Phone
- (507) 372-2941
- Fax
- (507) 372-7686
- NPI assigned
- Apr 18, 2007
- Last updated
- Nov 8, 2024
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1173 | MN | Primary |
| Registered Dietitian | 133V00000X | 01112 | IA |
Addresses
Primary practice location
1018 6TH Ave
Worthington, MN 56187-2202
Mailing address
PO Box 5074
Sioux Falls, SD 57117-5074
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1173 | MN | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sanford Health Network | Current | Accepting new patients | |
| Sanford Health Network | Current | Accepting new patients | |
| Sanford Health Network | Current | Accepting new patients | |
| Sanford Clinic | Past | Accepting new patients |
Locations
249 5th St E
Tracy, MN 56175
Phone (507) 629-3520
1018 6th Ave
Worthington, MN 56187
Phone (507) 343-6100
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Sanford Clinic Mountain Lake
- Rural Health Clinic/Center
- Mountain Lake, MN
- NPI 1568469039
-
dba Sanford Clinic Windom
- Rural Health Clinic/Center
- Windom, MN
- NPI 1699772178
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731024000000",
"number": "1114143948",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5074",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571175074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1018 6TH AVE",
"city": "WORTHINGTON",
"state": "MN",
"postal_code": "561872202",
"telephone_number": "507-372-2941",
"fax_number": "507-372-7686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POPPEN",
"first_name": "MICHELLE",
"middle_name": "J",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-18",
"last_updated": "2024-11-08",
"certification_date": "2024-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "1173",
"primary": true
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IA",
"license": "01112",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Worthington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.