NPIMap

Individual provider Active NPI

Anousheh Shafa, M.D.

  • Obstetrics & Gynecology Physician
  • St Louis Park, MN
National Provider Identifier
1225563836
Registry record updated Oct 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
64362 Issued in MN
Practice address
6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone
(952) 993-3282
NPI assigned
Apr 21, 2017
Last updated
Oct 3, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 28768 MN
Obstetrics & Gynecology Physician 207V00000X 64362 MN Primary
Gynecologic Oncology Physician 207VX0201X 64362 MN

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

200 1st St SW
Rochester, MN 55905
Phone (507) 284-2511

Other practice location 2

640 Jackson St # MS 21110W
Saint Paul, MN 55101-2502
Phone (651) 254-3448

Other identifiers 1

IdentifierTypeStateIssuer
1225563836OtherMNOTHER

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ashafa127329@ehrdirect.mayoclinicmsg.org

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
I20180814001612 MN Practitioner - Gynecological OncologyPractitioner - Obstetrics/Gynecology 9739453697 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Gynecological Oncology
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28768MNMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Obstetrics & Gynecology CurrentSince Oct 14, 2024 Accepting new patients
Mayo Clinic CurrentSince Jul 26, 2018 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Current Accepting new patients
Park Nicollet Methodist Hospital CurrentSince Oct 14, 2024 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Jul 13, 2021 Accepting new patients
Mayo Clinic CurrentSince Jul 26, 2018 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Oct 8, 2021 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Oct 8, 2021 Accepting new patients
Group Health, Inc. CurrentSince Oct 14, 2024 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Jul 13, 2021 Accepting new patients
Group Health, Inc. Current Accepting new patients
Park Nicollet Clinic Obstetrics & Gynecology Current Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region Current Accepting new patients
Mayo Clinic Current Accepting new patients
Group Health, Inc. CurrentSince Oct 14, 2024 Accepting new patients

Locations

404 W Fountain St
Albert Lea, MN 56007
Phone (507) 377-6285

1025 Marsh St
Mankato, MN 56001
Phone (507) 345-2623

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

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

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

301 2nd St NE
New Prague, MN 56071
Phone (952) 758-4431

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

640 Jackson St
#21110W
Saint Paul, MN 55101
Phone (651) 254-3448

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

Organizations & group practices 15

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 15

Hospital & facility affiliations 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1492732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727913600000",
    "number": "1225563836",
    "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": "952-993-3282"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 1st St SW",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "55905",
            "country_code": "US",
            "telephone_number": "507-284-2511",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "640 Jackson St # MS 21110W",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551012502",
            "country_code": "US",
            "telephone_number": "651-254-3448",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAFA",
        "first_name": "ANOUSHEH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-21",
        "last_updated": "2024-10-03",
        "certification_date": "2024-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "28768",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "64362",
            "primary": true
        },
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "MN",
            "license": "64362",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER",
            "identifier": "1225563836",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ashafa127329@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "200 1st St SW",
            "city": "Rochester",
            "state": "MN",
            "country_code": "US",
            "postal_code": "55905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.