Individual provider Active NPI

Nicole Lea Wentworth Hartung, M.D.

  • Medical Oncology Physician
  • Minneapolis, MN
National Provider Identifier
1255300885
Registry record updated Jul 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
License
43587 Issued in MN
Practice address
909 Fulton St SE
Minneapolis, MN 55455-4800
Phone
(612) 273-8383
NPI assigned
Mar 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology Physician 207RX0202X 43587 MN Primary

Addresses

Primary practice location

909 Fulton St SE
Minneapolis, MN 55455-4800

Mailing address

1700 University Ave W
Saint Paul, MN 55104-3727

Other practice location 1

110105 Pioneer Trl W Ste 302
Chaska, MN 55318-2680
Phone (952) 361-5800

Other identifiers 8

IdentifierTypeStateIssuer
HP33218OtherMNHEALTHPARTNERS
260472800MedicaidMN
3600166OtherMNMEDICA
69B77WEOtherMNBLUE CROSS BLUE SHIELD MN
140263OtherMNUCARE MN
34182800MedicaidWI
1027664OtherMNPREFERRED ONE
1383614OtherMNAMERICA'S PPO

Other names 1

  • Nicole L Wentworth Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040308000011 MN Practitioner - Medical Oncology 0648168138 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
88.63 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
43587MNMDMedical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Mar 1, 2020 Accepting new patients
Fairview Health Services Current Accepting new patients
Allina Health System Current Accepting new patients
Fairview Health Services CurrentSince Mar 19, 2020 Accepting new patients
Fairview Express Care CurrentSince Oct 1, 2020 Accepting new patients
Fairview Clinics CurrentSince Mar 1, 2020 Accepting new patients
Fairview Express Care CurrentSince Oct 1, 2020 Accepting new patients
Allina Health System CurrentSince Jun 1, 2012 Accepting new patients
Allina Health System CurrentSince Jun 1, 2012 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Health Services CurrentSince Mar 19, 2020 Accepting new patients
University Health Physicians Past Accepting new patients
Minnesota Oncology Hematology, PA Medical Oncology Past Accepting new patients
Minnesota Oncology Hematology, PA PastSince Jan 12, 2020 Accepting new patients

Locations

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

1805 Hennepin Ave N
Glencoe, MN 55336
Phone (320) 864-3121

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

516 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-3600

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100

Organizations & group practices 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1255300885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 UNIVERSITY AVE W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 FULTON ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554554800",
            "telephone_number": "612-273-8383"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110105 Pioneer Trl W Ste 302",
            "address_purpose": "LOCATION",
            "city": "Chaska",
            "state": "MN",
            "postal_code": "553182680",
            "country_code": "US",
            "telephone_number": "952-361-5800",
            "fax_number": "952-361-5858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARTUNG",
        "first_name": "NICOLE",
        "middle_name": "LEA WENTWORTH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-16",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "MN",
            "license": "43587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP33218",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "260472800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "3600166",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MN",
            "identifier": "69B77WE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MN",
            "identifier": "140263",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34182800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1027664",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICA'S PPO",
            "identifier": "1383614",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "WENTWORTH",
            "middle_name": "L",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.