NPIMap

Organization Active NPI

Park Nicollet Methodist Hospital

Doing business as PN Methodist Hospital Episodic Bundle

  • General Acute Care Hospital
  • St Louis Park, MN
National Provider Identifier
1245615772
Registry record updated Oct 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
371016 Issued in MN
Legal business name
PARK NICOLLET METHODIST HOSPITAL
Doing business as
PN Methodist Hospital Episodic Bundle
Practice address
6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone
(952) 993-5000
NPI assigned
Jul 27, 2015
Last updated
Oct 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2021

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

Authorized official

Name
Jason James Luhrs
Title
VP Finance
Phone
(952) 883-7158

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 371016 MN Primary

Addresses

Primary practice location

6500 Excelsior Blvd
St Louis Park, MN 55426-4702

Mailing address

PO Box 1488
Minneapolis, MN 55480-1488
Phone (952) 993-1990

Other identifiers 1

IdentifierTypeStateIssuer
407345200MedicaidMN

Other names 1

  • PN Methodist Hospital Episodic Bundle Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050606000573 MN Part A Provider - Hospital 7315840063 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Louis Park, MN; St Louis Park, MN; Saint Paul, MN; Maple Grove, MN; Golden Valley, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245615772. Details of each certification follow.

Hospital certification: CCN 240053

Legal name
PARK NICOLLET METHODIST HOSPITAL
Doing business as
METHODIST HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jan 10, 2014
Beds
426
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1893 in MN
Enrollment address
6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Hospital subgroups
General, Acute care, Rehabilitation, Rehabilitation unit

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Park Nicollet Methodist HospitalCCN 240053 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Back and Neck Clinic12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Craig Larson Individual W-2 Managing EmployeeDirector, Fin Plan & Rev RPTG Oct 1, 2013
Rae Ann Williams Individual Corporate Director Jan 1, 2018
Robert Ehren Individual Corporate Director Jan 1, 2024
Mark R Sannes Individual Corporate Officer Jan 1, 2025
Morris Goodwin Individual Corporate Director Jan 1, 2017
Jason Luhrs Individual Corporate DirectorVP Finance Sep 15, 2021
Park Nicollet Health Services Organization, St Louis Park, MN Non-profit Operational/Managerial Control Oct 23, 2007
Laura Liu Individual Corporate Director Jan 1, 2023
Kathleen a Kelley Individual Corporate Director Jan 1, 2021
Sherri Lynn Broderius Individual Corporate Director Jan 1, 2026
Bradley Wozney Individual Corporate Director Jan 1, 2019
Jerome C Siy Individual Corporate Officer Jan 1, 2026
Sharon Pierce Evan Individual Corporate Director Jan 1, 2020
Ana Lee Individual Corporate Director Jan 1, 2022
Paul D Williams Individual Corporate Director Jan 1, 2021
David Lagerstrom Individual Corporate Director Jan 1, 2022
Alita R Risinger Individual Corporate Director Apr 17, 2026
Lisa Bjorkman Individual W-2 Managing EmployeeAd; Jul 27, 2015
Mary Grove Individual Corporate Director Mar 19, 2025

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 1,790

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 1,790

NPI Registry JSON

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

{
    "created_epoch": "1437955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635120000000",
    "number": "1245615772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1488",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554801488",
            "telephone_number": "952-993-1990"
        },
        {
            "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": "952-993-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK NICOLLET METHODIST HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-27",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A",
        "authorized_official_last_name": "LUHRS",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "952-883-7158"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MN",
            "license": "371016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "407345200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PN Methodist Hospital Episodic Bundle",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PN Methodist Hospital Episodic Bundle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.