NPIMap

Organization Active NPI

Park Nicollet Methodist Hospital

  • General Acute Care Hospital
  • Maple Grove, MN
National Provider Identifier
1174980692
Registry record updated Aug 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
PARK NICOLLET METHODIST HOSPITAL
Practice address
15800 95TH Ave N
Maple Grove, MN 55369-4400
Phone
(952) 993-1440
NPI assigned
Jan 28, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2026

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

Authorized official

Name
Alita Risinger
Title
Sr Vice President, Cfo
Phone
(952) 883-5401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

15800 95TH Ave N
Maple Grove, MN 55369-4400

Mailing address

PO Box 1488
Minneapolis, MN 55480-1488

Other names 1

  • Park Nicollet Surgery Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050606000573 MN Part A Provider - Hospital 7315840063 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Louis Park, MN; St Louis Park, MN; Saint Paul, MN; Maple Grove, MN; Golden Valley, MN

Hospital certification: CCN 240053

Legal name
PARK NICOLLET METHODIST HOSPITAL
Doing business as
METHODIST HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jan 10, 2014
Beds
426
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1893 in MN
Enrollment address
6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Hospital subgroups
General, Acute care, Rehabilitation, Rehabilitation unit

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Park Nicollet Methodist HospitalCCN 240053
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2112635Park Nicollet Surgery Center15800 95TH Ave North, Maple Grove, MN 55369Certificate of waiverMay 3, 2028

National Provider Directory

National Provider Directory
Tax ID family
Back and Neck Clinic12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Craig Larson Individual W-2 Managing EmployeeDirector, Fin Plan & Rev RPTG Oct 1, 2013
Rae Ann Williams Individual Corporate Director Jan 1, 2018
Robert Ehren Individual Corporate Director Jan 1, 2024
Mark R Sannes Individual Corporate Officer Jan 1, 2025
Morris Goodwin Individual Corporate Director Jan 1, 2017
Jason Luhrs Individual Corporate DirectorVP Finance Sep 15, 2021
Park Nicollet Health Services Organization, St Louis Park, MN Non-profit Operational/Managerial Control Oct 23, 2007
Laura Liu Individual Corporate Director Jan 1, 2023
Kathleen a Kelley Individual Corporate Director Jan 1, 2021
Sherri Lynn Broderius Individual Corporate Director Jan 1, 2026
Bradley Wozney Individual Corporate Director Jan 1, 2019
Jerome C Siy Individual Corporate Officer Jan 1, 2026
Sharon Pierce Evan Individual Corporate Director Jan 1, 2020
Ana Lee Individual Corporate Director Jan 1, 2022
Paul D Williams Individual Corporate Director Jan 1, 2021
David Lagerstrom Individual Corporate Director Jan 1, 2022
Alita R Risinger Individual Corporate Director Apr 17, 2026
Lisa Bjorkman Individual W-2 Managing EmployeeAd; Jul 27, 2015
Mary Grove Individual Corporate Director Mar 19, 2025

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 1,790

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 1,790

NPI Registry JSON

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

{
    "created_epoch": "1453939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785715200000",
    "number": "1174980692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1488",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554801488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15800 95TH AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694400",
            "telephone_number": "952-993-1440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK NICOLLET METHODIST HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-28",
        "last_updated": "2026-08-03",
        "certification_date": "2026-08-03",
        "status": "A",
        "authorized_official_last_name": "RISINGER",
        "authorized_official_first_name": "ALITA",
        "authorized_official_title_or_position": "SR VICE PRESIDENT, CFO",
        "authorized_official_telephone_number": "952-883-5401"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Nicollet Surgery Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Park Nicollet Surgery Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.