Individual provider Active NPI

Laura Joyce-Carlson Ross, PA-C

  • Physician Assistant
  • St Louis Park, MN
National Provider Identifier
1245217181
Registry record updated Jul 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9898 Issued in MN
Practice address
6500 Excelsior Blvd
Park Nicollet Heart and Vascular Center
St Louis Park, MN 55426-4702
Phone
(952) 993-2304
Fax
(952) 993-3010
NPI assigned
Dec 30, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9898 MN Primary

Addresses

Primary practice location

6500 Excelsior Blvd
Park Nicollet Heart and Vascular Center
St Louis Park, MN 55426-4702

Mailing address

6500 Excelsior Blvd
Park Nicollet Heart and Vascular Center
St Louis Park, MN 55426-4702
Phone (952) 993-2304

Other identifiers 1

IdentifierTypeStateIssuer
463918900MedicaidMN

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050315000563 MN Practitioner - Physician Assistant 2365497104 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
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

Practice addresses (Care Compare)

1415 Saint Francis Ave
Shakopee, MN 55379-3374
Phone (952) 993-7750

15111 Twelve Oaks Ctr Dr
Minnetonka, MN 55305-5201
Phone (952) 993-4500

15800 95TH Ave N
Maple Grove, MN 55369-4400
Phone (952) 993-1440

1885 Plaza Dr
Eagan, MN 55122-2979
Phone (952) 993-4001

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-3123

Hospital & facility affiliations

  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Aug 1, 2004 Accepting new patients

Locations

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

1515 Saint Francis Ave
Ste 145
Shakopee, MN 55379
Phone (952) 241-5873

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

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.

Hospital & facility affiliations 6

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": "1135900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342742400000",
    "number": "1245217181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 EXCELSIOR BLVD",
            "address_2": "PARK NICOLLET HEART AND VASCULAR CENTER",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264702",
            "telephone_number": "952-993-2304",
            "fax_number": "952-993-3010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 EXCELSIOR BLVD",
            "address_2": "PARK NICOLLET HEART AND VASCULAR CENTER",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264702",
            "telephone_number": "952-993-2304",
            "fax_number": "952-993-3010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "LAURA",
        "middle_name": "JOYCE-CARLSON",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-30",
        "last_updated": "2012-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "463918900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.