NPIMap

Organization Active NPI

Park Nicollet Health Care Products

  • Durable Medical Equipment & Medical Supplies
  • Burnsville, MN
National Provider Identifier
1265494777
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PARK NICOLLET HEALTH CARE PRODUCTS
Practice address
14000 Fairview Dr
Burnsville, MN 55337-5713
Phone
(952) 993-8700
Fax
(952) 993-0562
NPI assigned
Apr 3, 2006
Last updated
Nov 7, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
PARK NICOLLET HEALTH SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Authorized official

Name
Kristin Denise Brey
Title
Supervisor/Delegated Official
Phone
(952) 993-6832

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary
Eyewear Supplier 332H00000X
Hearing Aid Equipment 332S00000X MN

Addresses

Primary practice location

14000 Fairview Dr
Burnsville, MN 55337-5713

Mailing address

3800 Park Nicollet Blvd # Ms 61901C
St Louis Park, MN 55416-2527

Other identifiers 2

IdentifierTypeStateIssuer
046098200MedicaidMN
21398500MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930073370 MN DME Supplier - Medical Supply Company 2365655164 1 other NPI on this enrollment
Practice locations: Burnsville, MN

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Park Nicollet Health Care Products14000 Fairview Dr, Burnsville, MN 55337-5713(952) 993-8700 Ultraviolet Light Devices and/or Supplies|Canes and/or Crutches|Walkers|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|Continuous Positive Airway Pressure (CPAP) Devices|Nebulizer Equipment and/or Supplies|Surgical Dressings|Lymphedema Compression Treatment Items Does not accept assignmentParticipating since Jul 1, 2002

National Provider Directory

National Provider Directory
Tax ID family
Park Nicollet Health Services10 organizations share this tax ID, including this one
Part of
Park Nicollet

Other organizations with this tax ID 9

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

NPI Registry JSON

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1265494777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 PARK NICOLLET BLVD # MS 61901C",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162527",
            "fax_number": "952-993-0562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14000 FAIRVIEW DR",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553375713",
            "telephone_number": "952-993-8700",
            "fax_number": "952-993-0562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK NICOLLET HEALTH CARE PRODUCTS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PARK NICOLLET HEALTH SERVICES",
        "enumeration_date": "2006-04-03",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "BREY",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "SUPERVISOR/DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "952-993-6832"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332S00000X",
            "taxonomy_group": "",
            "desc": "Hearing Aid Equipment",
            "state": "MN",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046098200",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21398500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.