NPIMap

Individual provider Active NPI

Josh Kruize

  • Physician Assistant
  • Wayzata, MN
National Provider Identifier
1144857673
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13454 Issued in MN
Practice address
250 Central Ave N Ste 228
Wayzata, MN 55391-1208
Phone
(952) 993-8250
NPI assigned
Mar 25, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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 13454 MN Primary

Addresses

Primary practice location

250 Central Ave N Ste 228
Wayzata, MN 55391-1208

Mailing address

8170 33Rd Ave S # Ms 21110Q
Bloomington, MN 55425-4516

Other practice location 1

3200 Grand Ave
Des Moines, IA 50312-4104
Phone (515) 271-1569

Other practice location 2

200 Elm St N
Onamia, MN 56359-7901
Phone (320) 532-3154

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
I20200911000677 MN Practitioner - Physician Assistant 6800214560 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

250 Central Ave N
Wayzata, MN 55391-1206
Phone (952) 993-3123

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

Hospital & facility affiliations

  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13454MNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mille Lacs Health System CurrentSince Aug 17, 2020 Accepting new patients
Park Nicollet Clinic CurrentSince Nov 4, 2024 Accepting new patients
Mille Lacs Health System Current Accepting new patients
Mille Lacs Health System Current Accepting new patients
Park Nicollet Clinic CurrentSince Nov 4, 2024 Accepting new patients
Mille Lacs Health System Current Accepting new patients
Mille Lacs Health System Physician Assistant CurrentSince Aug 17, 2020 Accepting new patients
Park Nicollet Clinic PastSince Oct 13, 2024 Accepting new patients

Locations

27378 State Highway 18
Garrison, MN 56450
Phone (320) 692-5599

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

200 Elm St N
Onamia, MN 56359
Phone (320) 532-2750

250 Central Ave N
Ste 220
Wayzata, MN 55391
Phone (952) 993-8250

250 Central Ave N
Ste 228
Wayzata, MN 55391
Phone (952) 993-8250

250 Central Ave N
Ste 103
Wayzata, MN 55391
Phone (952) 249-2000

Organizations & group practices 9

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 6

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": "1585094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1144857673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 CENTRAL AVE N STE 228",
            "city": "WAYZATA",
            "state": "MN",
            "postal_code": "553911208",
            "telephone_number": "952-993-8250"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 Grand Ave",
            "address_purpose": "LOCATION",
            "city": "Des Moines",
            "state": "IA",
            "postal_code": "503124104",
            "country_code": "US",
            "telephone_number": "515-271-1569",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Elm St N",
            "address_purpose": "LOCATION",
            "city": "Onamia",
            "state": "MN",
            "postal_code": "563597901",
            "country_code": "US",
            "telephone_number": "320-532-3154",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRUIZE",
        "first_name": "JOSH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-25",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayzata, MN

Sources for this page

Verify at the official NPI Registry.