NPIMap

Individual provider Active NPI

Jessica Jerich Wetterlin, M.D.

  • Urology Physician
  • Saint Paul, MN
National Provider Identifier
1245529379
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
66275 Issued in MN
Practice address
435 Phalen Blvd
Ms 51103C
St. Paul, MN 55130
Phone
(651) 254-8500
NPI assigned
Mar 29, 2011
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 66275 MN Primary
Surgery Physician 208600000X 1245529379 IL
Urology Physician 208800000X 4301112391 MI

Addresses

Primary practice location

435 Phalen Blvd
Ms 51103C
St. Paul, MN 55130

Mailing address

8170 33Rd Ave S
Ms 21110Q
Bloomington, MN 55425-4516
Phone (651) 254-8500

Other practice location 1

577 Michigan Ave Ste 201
Holland, MI 49423
Phone (616) 392-1816

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
I20191111002923 MN Practitioner - Urology 5597066142 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Saint Louis University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

435 Phalen Blvd
Saint Paul, MN 55130-5302
Phone (651) 291-2848

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1245529379ILMDSurgery Physician
66275MNMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. Current Accepting new patients
Group Health, Inc. CurrentSince Dec 2, 2019 Accepting new patients
Group Health Plan, Inc. CurrentSince Dec 2, 2019 Accepting new patients

Locations

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

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

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

435 Phalen Blvd
Saint Paul, MN 55130
Phone (651) 254-3200

435 Phalen Blvd
#51103C
Saint Paul, MN 55130
Phone (651) 254-8500

233 Radio Dr
Woodbury, MN 55125
Phone (651) 254-7400

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1301356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1245529379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "address_2": "MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516",
            "telephone_number": "651-254-8500",
            "fax_number": "651-254-8504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 PHALEN BLVD",
            "address_2": "MS 51103C",
            "city": "ST. PAUL",
            "state": "MN",
            "postal_code": "55130",
            "telephone_number": "651-254-8500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "577 Michigan Ave Ste 201",
            "address_purpose": "LOCATION",
            "city": "Holland",
            "state": "MI",
            "postal_code": "49423",
            "country_code": "US",
            "telephone_number": "616-392-1816",
            "fax_number": "616-392-1292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WETTERLIN",
        "first_name": "JESSICA",
        "middle_name": "JERICH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-29",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MN",
            "license": "66275",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "1245529379",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MI",
            "license": "4301112391",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.