NPIMap

Individual provider Active NPI

Jacob Douglas Collins, DO

  • Emergency Medicine Physician
  • Bloomington, MN
National Provider Identifier
1245850627
Registry record updated Aug 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
74134 Issued in MN
Practice address
4300 Market Pte Dr Ste 100
Bloomington, MN 55435-5435
Phone
(612) 209-5115
NPI assigned
Apr 25, 2020
Last updated
Aug 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 74134 MN Primary

Addresses

Primary practice location

4300 Market Pte Dr Ste 100
Bloomington, MN 55435-5435

Mailing address

4300 Market Pte Dr Ste 100
Bloomington, MN 55435-5435
Phone (952) 767-4574

Other practice location 1

4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522
Phone (952) 767-4574

Other practice location 2

701 Dellwood St S
Cambridge, MN 55008-1920
Phone (952) 767-4574

Other practice location 3

303 Catlin St
Buffalo, MN 55313-1947
Phone (952) 767-4574

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
I20230630002054 MN Practitioner - Emergency Medicine 0143642058 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4300 Marketpointe Dr
Suite 100
Bloomington, MN 55435-5435
Phone (952) 835-9880

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
94.23
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
74134MNMDEmergency Medicine Physician
31079MNMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians Professional Association CurrentSince Aug 1, 2023 Accepting new patients
Emergency Physicians Professional Association Emergency Medicine CurrentSince Aug 1, 2023 Accepting new patients

Locations

303 Catlin St
Buffalo, MN 55313
Phone (763) 682-1212

701 Dellwood St S
Cambridge, MN 55008
Phone (763) 689-7700

4050 Coon Rapids Blvd NW
Minneapolis, MN 55433
Phone (763) 236-6786

4300 Marketpointe Dr
Ste 100
Minneapolis, MN 55435
Phone (952) 767-4574

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

Hospital & facility affiliations 9

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": "1587772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1245850627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 MARKET PTE DR STE 100",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554355435",
            "telephone_number": "952-767-4574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 MARKET PTE DR STE 100",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554355435",
            "telephone_number": "612-209-5115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4050 Coon Rapids Blvd NW",
            "address_purpose": "LOCATION",
            "city": "Coon Rapids",
            "state": "MN",
            "postal_code": "554332522",
            "country_code": "US",
            "telephone_number": "952-767-4574",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "701 Dellwood St S",
            "address_purpose": "LOCATION",
            "city": "Cambridge",
            "state": "MN",
            "postal_code": "550081920",
            "country_code": "US",
            "telephone_number": "952-767-4574",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "303 Catlin St",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "MN",
            "postal_code": "553131947",
            "country_code": "US",
            "telephone_number": "952-767-4574",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLLINS",
        "first_name": "JACOB",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-25",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "74134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, MN

Sources for this page

Verify at the official NPI Registry.