NPIMap

Individual provider Active NPI

Nicole Staloch, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Fridley, MN
National Provider Identifier
1134524242
Registry record updated Apr 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
2825 Issued in MN
Practice address
520 Osborne Rd NE Ste 120
Fridley, MN 55432-2718
Phone
(763) 236-4300
NPI assigned
Oct 31, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R165333-3 MN
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 2825 MN Primary

Addresses

Primary practice location

520 Osborne Rd NE Ste 120
Fridley, MN 55432-2718

Mailing address

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-5000

Other practice location 1

559 Capitol Blvd
Saint Paul, MN 55103-2101
Phone (651) 500-7737

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141230002458 MN Practitioner - Nurse Practitioner 1658694492 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

150 Emerson Ave E
West St Paul, MN 55118-2535
Phone (651) 241-1800

520 Osborne Rd NE
Suite 120
Fridley, MN 55432-2718
Phone (763) 236-4300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R165333-3MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System Current Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Allina Health System CurrentSince Jan 19, 2023 Accepting new patients
Healtheast Medical Research Institute CurrentSince Dec 15, 2014 Accepting new patients
Healtheast Medical Research Institute CurrentSince Dec 15, 2014 Accepting new patients
Allina Health System CurrentSince Feb 9, 2020 Accepting new patients
Allina Health System Current Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

520 Osborne Rd NE
Ste 120
Fridley, MN 55432
Phone (763) 236-4300

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

800 E 28th St
Ste H2100
Minneapolis, MN 55407
Phone (612) 863-3900

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

1700 University Ave W
Fl 1
Saint Paul, MN 55104
Phone (651) 232-2002

559 Capitol Blvd
Saint Paul, MN 55103
Phone (651) 232-2000

150 Emerson Ave E
West St Paul, MN 55118
Phone (651) 241-1800

Organizations & group practices 7

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.

Hospital & facility affiliations 8

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": "1414713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744070400000",
    "number": "1134524242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 OSBORNE RD NE STE 120",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322718",
            "telephone_number": "763-236-4300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "559 Capitol Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551032101",
            "country_code": "US",
            "telephone_number": "651-500-7737",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STALOCH",
        "first_name": "NICOLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-31",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R165333-3",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "2825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fridley, MN

Sources for this page

Verify at the official NPI Registry.