Glen P Carlson, MD
Individual provider Active NPI Internal Medicine Physician · Champlin, MN
NPI 1245217231 · NPPES record last updated Apr 4, 2016
Key facts
- NPI
- 1245217231
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 44524 (MN)
- Practice address
- 12142 Business Park Blvd N
Champlin, MN 55316-4525 - Phone
- (952) 977-0500
- NPI assigned
- Dec 29, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Pediatric Medicine
- Education
- Loyola University of Chicago, Stritch School of Medicine, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Park Nicollet Clinic
Practice addresses (Care Compare)
12142 Business Park Blvd N
Champlin, MN 55316-4525
Phone (952) 977-0500
5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400
Hospital & facility affiliations
- Park Nicollet Methodist Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100222000457 | MN | Practitioner - Pediatric Medicine |
9830233303 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Nicollet Clinic | Pediatrics | Current |
Accepting new patients |
| Park Nicollet Clinic | Pediatrics | Current | Accepting new patients |
| Park Nicollet Methodist Hospital | Current |
Accepting new patients |
Locations
12142 Business Park Blvd N
Champlin, MN 55316
Phone (952) 977-0500
5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 44524 | MN | Yes |
| Pediatrics Physician | 208000000X | 44524 | MN |
Addresses
Primary practice location
12142 Business Park Blvd N
Champlin, MN 55316-4525
Mailing address
8170 33Rd Ave S
PO Box 1309 Mail Stop 21110Q
Minneapolis, MN 55425-4516
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 088244500 | Medicaid | MN |
Other providers in Champlin, MN
- Madison Byron
- Brian C Calderon
- Angela Marie Campos
- Saturia Massah Cappard
- Care Mobility LLP
- Anne M Carroll
- Champlin Dentistry, PC
- Champlin Family Chiropractic LLC
- Champlin Family Dental PA
- Champlin Shores LLC
All providers in Champlin, MN · Internal Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.