NPIMap

Individual provider Active NPI

Jordyn Louise Massop, PA-C

  • Physician Assistant
  • St Louis Park, MN
National Provider Identifier
1154031334
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
14336 Issued in MN
Practice address
6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone
(612) 242-4285
NPI assigned
Nov 29, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 14336 MN Primary

Addresses

Primary practice location

6500 Excelsior Blvd
St Louis Park, MN 55426-4702

Mailing address

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

Other practice location 1

8325 34th Ave N
New Hope, MN 55427-1828
Phone (612) 242-4285

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
I20230410001558 MN Practitioner - Physician Assistant 6800261611 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

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

640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 221-3456

6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-3123

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

Hospital & facility affiliations

  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053
  • Regions Hospital Hospital, Saint Paul, MN, CCN 240106
  • Hutchinson Health Hospital, Hutchinson, MN, CCN 240187

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14336MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Apr 17, 2023 Accepting new patients
Group Health Plan, Inc. CurrentSince Apr 17, 2023 Accepting new patients
Group Health, Inc. CurrentSince Apr 17, 2023 Accepting new patients
Park Nicollet Methodist Hospital CurrentSince Apr 17, 2023 Accepting new patients
Group Health, Inc. Past Accepting new patients

Locations

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

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

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

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

6500 Excelsior Blvd
St Louis Park, MN 55426
Phone (952) 993-3246

6500 Excelsior Blvd
Fl 5
St Louis Park, MN 55426
Phone (952) 993-0377

Organizations & group practices 6

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1669680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1154031334",
    "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": "6500 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264702",
            "telephone_number": "612-242-4285"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8325 34th Ave N",
            "address_purpose": "LOCATION",
            "city": "New Hope",
            "state": "MN",
            "postal_code": "554271828",
            "country_code": "US",
            "telephone_number": "612-242-4285",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MASSOP",
        "first_name": "JORDYN",
        "middle_name": "LOUISE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-29",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.