Individual provider Active NPI

Michael Ekern, M.D.

  • Psychiatry Physician
  • Saint Louis Park, MN
National Provider Identifier
1205811072
Registry record updated Mar 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
37344 Issued in MN
Practice address
3800 Park Nicollet Blvd
Saint Louis Park, MN 55416-2527
Phone
(952) 993-3708
NPI assigned
Dec 14, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 37344 MN Primary

Addresses

Primary practice location

3800 Park Nicollet Blvd
Saint Louis Park, MN 55416-2527

Mailing address

8170 33Rd Ave S
PO Box 1309 Mail Stop 21110Q
Minneapolis, MN 55425-4516
Phone (952) 993-3123

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050920000399 MN Practitioner - PsychiatryPractitioner - Geriatric Psychiatry 9537193537 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Nov 1, 2005 Accepting new patients
Park Nicollet Clinic Current Accepting new patients
Park Nicollet Clinic CurrentSince Nov 1, 2005 Accepting new patients

Locations

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

3800 Park Nicollet Blvd
St Louis Park, MN 55416
Phone (952) 993-1000

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456790400000",
    "number": "1205811072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "address_2": "PO BOX 1309 MAIL STOP 21110Q",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554254516",
            "telephone_number": "952-993-3123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 PARK NICOLLET BLVD",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554162527",
            "telephone_number": "952-993-3708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EKERN",
        "first_name": "MICHAEL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-14",
        "last_updated": "2016-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "37344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis Park, MN

Sources for this page

Verify at the official NPI Registry.