NPIMap

Individual provider Active NPI

Paul C Nystrom, M.D.

  • Emergency Medicine Physician
  • Bloomington, MN
National Provider Identifier
1164445052
Registry record updated May 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
53822 Issued in MN
Practice address
4300 Marketpointe Dr Ste 100
Bloomington, MN 55435-5435
Phone
(952) 835-9880
NPI assigned
Jul 25, 2006
Last updated
May 28, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 53822 MN Primary

Addresses

Primary practice location

4300 Marketpointe Dr Ste 100
Bloomington, MN 55435-5435

Mailing address

4300 Market Pte Dr Ste 100
Bloomington, MN 55435-5435
Phone (952) 767-4574

Other practice location 1

701 Park Ave
ED Dept
Minneapolis, MN 55415-1623
Phone (612) 873-5645

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120809000854 MN Practitioner - Emergency Medicine 4587742416 Reassigns benefits to 4 organizations
I20240917000670 WI Practitioner - Emergency Medicine 4587742416 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4300 Marketpointe Dr
Suite 100
Bloomington, MN 55435-5435
Phone (952) 835-9880

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
53822MNMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians Professional Association CurrentSince Nov 1, 2024 Accepting new patients
Grand Itasca Clinic and Hospital CurrentSince Jun 1, 2022 Accepting new patients
Gundersen Lutheran Medical Center Inc Current Accepting new patients
Gundersen Lutheran Medical Center Inc Current Accepting new patients
Gundersen Lutheran Medical Center, Inc. CurrentSince Aug 4, 2024 Accepting new patients
Saint Elizabeths Hospital of Wabasha Inc CurrentSince Sep 23, 2022 Accepting new patients
Grand Itasca Clinic and Hospital CurrentSince Jun 1, 2022 Accepting new patients
Emergency Physicians Professional Association CurrentSince Nov 1, 2024 Accepting new patients
Emergency Physicians Professional Association Emergency Medicine Current Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince Aug 4, 2024 Accepting new patients
Saint Elizabeths Hospital of Wabasha Inc CurrentSince Sep 23, 2022 Accepting new patients
Gundersen Lutheran Medical Center Inc CurrentSince Aug 4, 2024 Accepting new patients
Range Regional Health Services Past Accepting new patients

Locations

111 SE 3rd St
Grand Rapids, MN 55744
Phone (218) 326-3401

1601 Golf Course Rd
Grand Rapids, MN 55744
Phone (218) 326-3401

750 E 34th St
Hibbing, MN 55746
Phone (218) 262-3441

4300 Marketpointe Dr
Ste 100
Minneapolis, MN 55435
Phone (952) 767-4574

1200 Grant Blvd W
Wabasha, MN 55981
Phone (651) 565-4531

301 Becker Ave SW
Willmar, MN 56201
Phone (320) 231-4120

1122 W Highway 61
Winona, MN 55987
Phone (507) 615-0600

1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102

1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

Interoperability endpoints

  • Direct secure messaging: paul.nystrom.1@24063.direct.athenahealth.com
  • Direct secure messaging: pnystrom737950@direct.emplifyhealth.org

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 10

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779926400000",
    "number": "1164445052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 MARKET PTE DR STE 100",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554355435",
            "telephone_number": "952-767-4574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 MARKETPOINTE DR STE 100",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554355435",
            "telephone_number": "952-835-9880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Park Ave",
            "address_2": "ED Dept",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554151623",
            "country_code": "US",
            "telephone_number": "612-873-5645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NYSTROM",
        "first_name": "PAUL",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2026-05-28",
        "certification_date": "2026-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "53822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, MN

Sources for this page

Verify at the official NPI Registry.