NPIMap

Individual provider Active NPI

Nathanael Paul Shull

  • Physician Assistant
  • Shoreview, MN
National Provider Identifier
1255034054
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
14956 Issued in MN
Practice address
4194 Lexington Ave N
Shoreview, MN 55126-6106
Phone
(651) 483-5461
Fax
(651) 483-2155
NPI assigned
Mar 22, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

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
Physician Assistant 363A00000X 14956 MN Primary

Addresses

Primary practice location

4194 Lexington Ave N
Shoreview, MN 55126-6106

Mailing address

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-5000

Other practice location 1

4839 305th Ave NE
Cambridge, MN 55008-6707
Phone (612) 413-6460

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
I20240819001362 MN Practitioner - Physician Assistant 5496293714 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

4166 Lexington Ave N
Shoreview, MN 55126-6106
Phone (651) 241-1306

4194 Lexington Ave N
Shoreview, MN 55126-6106
Phone (651) 483-5461

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14956MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Oct 1, 2024 Accepting new patients
Allina Health System CurrentSince Oct 1, 2024 Accepting new patients
Allina Health System Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

4194 Lexington Ave N
Shoreview, MN 55126
Phone (651) 483-5461

Interoperability endpoints

  • Direct secure messaging: nshull674302@excellian.direct.allina.com

Organizations & group practices 4

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 46

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

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1679443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1255034054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4194 LEXINGTON AVE N",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551266106",
            "telephone_number": "651-483-5461",
            "fax_number": "651-483-2155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4839 305th Ave NE",
            "address_purpose": "LOCATION",
            "city": "Cambridge",
            "state": "MN",
            "postal_code": "550086707",
            "country_code": "US",
            "telephone_number": "612-413-6460",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHULL",
        "first_name": "NATHANAEL",
        "middle_name": "PAUL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-22",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shoreview, MN

Sources for this page

Verify at the official NPI Registry.