Individual provider Active NPI

Jacqueline Lee, APRN, CNP

  • Acute Care Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1285138719
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
5641 Issued in MN
Practice address
701 Park Ave
Minneapolis, MN 55415-1623
Phone
(612) 873-3000
NPI assigned
Mar 20, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 5641 MN
Acute Care Nurse Practitioner 363LA2100X 5641 MN Primary

Addresses

Primary practice location

701 Park Ave
Minneapolis, MN 55415-1623

Mailing address

701 Park Ave
Minneapolis, MN 55415-1623
Phone (128) 733-0006

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180828000496 MN Practitioner - Nurse Practitioner 7618226457 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hennepin Healthcare System IncGroup PAC ID 4789684861, 905 clinicians

Practice addresses (Care Compare)

701 Park Ave
Minneapolis, MN 55415-1623
Phone (612) 873-6963

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5641MNMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Health System-NR LLC CurrentSince Oct 1, 2022 Accepting new patients
Centracare Clinic CurrentSince Sep 10, 2018 Accepting new patients
Centracare Health System-NR LLC Current Accepting new patients
Hennepin Healthcare System Inc CurrentSince Oct 2, 2024 Accepting new patients
Hennepin Healthcare System, Inc Current Accepting new patients
Hennepin Healthcare System, Inc CurrentSince Oct 2, 2024 Accepting new patients
Centracare Clinic Current Accepting new patients
Centracare Clinic CurrentSince Sep 10, 2018 Accepting new patients
Centracare Clinic Past Accepting new patients
Hennepin Healthcare System, Inc Past Accepting new patients
Centracare Clinic Past Accepting new patients
Hennepin Faculty Associates Past Accepting new patients

Locations

701 Park Ave
Minneapolis, MN 55415
Phone (612) 873-6005

1013 Hart Blvd
Monticello, MN 55362
Phone (763) 271-2303

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

Interoperability endpoints

  • Direct secure messaging: jlee698849@excellian.direct.allina.com

Organizations & group practices 12

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 1

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": "1521504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1285138719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151623",
            "telephone_number": "128-733-0006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151623",
            "telephone_number": "612-873-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "JACQUELINE",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-20",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "5641",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MN",
            "license": "5641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.