Active NPI
Lauren Gimmestad
- Physician Assistant
- Waite Park, MN
National Provider Identifier
1215515580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 430 Great Oak Dr
Waite Park, MN 56387-2504 - Phone
- (320) 203-2400
- NPI assigned
- Mar 30, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
430 Great Oak Dr
Waite Park, MN 56387-2504
Mailing address
PO Box 1309
Minneapolis, MN 55440-1309
Phone (763) 567-8542
Other practice location 1
927 Churchill St W
Stillwater, MN 55082-6605
Phone (651) 439-5330
Other practice location 2
640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 254-3456
Other practice location 3
405 Stageline Rd
Hudson, WI 54016-7848
Phone (715) 531-6000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Group Health, Inc. | Past | Accepting new patients | |
| Park Nicollet Clinic | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Multi-Specialty Clinic/Center
- Minneapolis, MN
- NPI 1710924683
-
- Family Medicine Physician
- St Louis Park, MN
- NPI 1780621904
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617062400000",
"number": "1215515580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1309",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554401309",
"telephone_number": "763-567-8542"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "430 GREAT OAK DR",
"city": "WAITE PARK",
"state": "MN",
"postal_code": "563872504",
"telephone_number": "320-203-2400"
}
],
"practiceLocations": [
{
"address_1": "927 Churchill St W",
"address_purpose": "LOCATION",
"city": "Stillwater",
"state": "MN",
"postal_code": "550826605",
"country_code": "US",
"telephone_number": "651-439-5330",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "640 Jackson St",
"address_purpose": "LOCATION",
"city": "Saint Paul",
"state": "MN",
"postal_code": "551012502",
"country_code": "US",
"telephone_number": "651-254-3456",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "405 Stageline Rd",
"address_purpose": "LOCATION",
"city": "Hudson",
"state": "WI",
"postal_code": "540167848",
"country_code": "US",
"telephone_number": "715-531-6000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GIMMESTAD",
"first_name": "LAUREN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-30",
"last_updated": "2021-03-30",
"certification_date": "2021-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Waite Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.