NPIMap

Organization Active NPI

Park Nicollet Health Care Products

  • Durable Medical Equipment & Medical Supplies
  • Woodbury, MN
National Provider Identifier
1144749862
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
6019472 Issued in MN
Legal business name
PARK NICOLLET HEALTH CARE PRODUCTS
Practice address
155 Radio Drive
Woodbury, MN 55125-2040
Phone
(952) 831-8742
Fax
(952) 993-0562
NPI assigned
Sep 13, 2017
Organization subpart
Yes
Parent organization
PARK NICOLLET HEALTH SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Authorized official

Name
Kristin D Brey
Title
Supervisor/Delegated Official
Phone
(952) 993-6832

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 6019472 MN Primary

Addresses

Primary practice location

155 Radio Drive
Woodbury, MN 55125-2040

Mailing address

3800 Park Nicollet Blvd # Ms 61901C
St Louis Park, MN 55416-2527

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180228000453 MN DME Supplier - Medical Supply Company 2365655164 Practice locations: Woodbury, MN

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Park Nicollet Health Care Products155 Radio Dr, Woodbury, MN 55125-2619(952) 831-8742 Commodes, Urinals, Bedpans|Heat & Cold Applications|Neuromuscular Elect Stimulators (NMES)/Supplies|Pneumatic Compression Devices and/or Supplies|Traction Equipment|Ultraviolet Light Devices and/or Supplies|Canes and/or Crutches|Walkers|Orthoses: Off-The-Shelf|Urological Supplies|Intermittent Posit… Does not accept assignmentParticipating since Jul 1, 2002

National Provider Directory

National Provider Directory
Tax ID family
Park Nicollet10 organizations share this tax ID, including this one
Part of
Park Nicollet

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1505260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1144749862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 PARK NICOLLET BLVD # MS 61901C",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162527",
            "fax_number": "952-993-0562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 RADIO DRIVE",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252040",
            "telephone_number": "952-831-8742",
            "fax_number": "952-993-0562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK NICOLLET HEALTH CARE PRODUCTS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PARK NICOLLET HEALTH SERVICES",
        "enumeration_date": "2017-09-13",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "BREY",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "SUPERVISOR/DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "952-993-6832"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MN",
            "license": "6019472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; 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.