Individual provider Active NPI

Marina Nicole Melby

  • Physician Assistant
  • Minneapolis, MN
National Provider Identifier
1114602265
Registry record updated Jul 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
15371 Issued in MN
Practice address
909 Fulton St SE
Minneapolis, MN 55455-4800
Phone
(612) 273-8383
NPI assigned
Jun 16, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 15371 MN Primary

Addresses

Primary practice location

909 Fulton St SE
Minneapolis, MN 55455-4800

Mailing address

1201 104TH Ave W
Duluth, MN 55808-1724

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250721003903 MN Practitioner - Physician Assistant 7618483223 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Wisconsin School of Medicine, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

14500 99TH Ave N
Suite 100
Maple Grove, MN 55369-4738
Phone (763) 898-1000

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

717 Delaware St SE
Suite 340
Minneapolis, MN 55414-2959
Phone (612) 672-7422

909 Fulton St SE
Minneapolis, MN 55455-4800
Phone (612) 672-7422

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
15371MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care CurrentSince Aug 1, 2025 Accepting new patients
University of Minnesota Physicians CurrentSince Aug 1, 2025 Accepting new patients
Healtheast Medical Research Institute CurrentSince Sep 1, 2025 Accepting new patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince Aug 1, 2025 Accepting new patients
University of Minnesota Physicians CurrentSince Aug 1, 2025 Accepting new patients
Fairview Health Services Past Accepting new patients

Locations

303 E Nicollet Blvd
Ste 300
Burnsville, MN 55337
Phone (952) 435-4140

14500 99th Ave N
Ste 100
Maple Grove, MN 55369
Phone (763) 898-1000

720 Washington Ave SE
Ste 300
Minneapolis, MN 55414
Phone (612) 884-0769

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

6401 France Ave S
Minneapolis, MN 55435
Phone (952) 920-8477

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

Interoperability endpoints

  • Direct secure messaging: mmelby2683604@fairview.direct-ci.com

Organizations & group practices 10

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1686873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753488000000",
    "number": "1114602265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 104TH AVE W",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558081724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 FULTON ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554554800",
            "telephone_number": "612-273-8383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELBY",
        "first_name": "MARINA",
        "middle_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-16",
        "last_updated": "2025-07-26",
        "certification_date": "2025-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "15371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.