NPIMap

Individual provider Active NPI

Andrew N Nottleson, MD

  • Family Medicine Physician
  • Roseville, MN
National Provider Identifier
1295700854
Registry record updated Nov 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
38038 Issued in MN
Practice address
2831 Snelling Ave N
Roseville, MN 55113-1712
Phone
(651) 765-5900
Fax
(651) 765-5901
NPI assigned
Feb 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 38038 MN Primary

Addresses

Primary practice location

2831 Snelling Ave N
Roseville, MN 55113-1712

Mailing address

8170 33Rd Ave S # Ms 21110Q
Minneapolis, MN 55425-4516
Phone (952) 967-6620

Other identifiers 1

IdentifierTypeStateIssuer
165213300MedicaidMN

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
I20050615000579 MN Practitioner - Family Practice 2365486842 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Wisconsin School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians
Optage IncGroup PAC ID 2264619345, 61 clinicians

Practice addresses (Care Compare)

2831 Snelling N Ave
Roseville, MN 55113-2460
Phone (651) 636-4525

2945 Lincoln Dr
Roseville, MN 55113-1338
Phone (651) 631-6570

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Brooklyn Park, MN, CCN 247145
  • Lifespark Home Health Home health agency, Saint Louis Park, MN, CCN 248118
  • St Croix Hospice Hospice, Oakdale, MN, CCN 241586
  • Regions Hospital Hospital, Saint Paul, MN, CCN 240106
  • M Health Fairview St John'S Hospital Hospital, Maplewood, MN, CCN 240210

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
38038MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. Family Medicine CurrentSince May 1, 2005 Accepting new patients
Group Health, Inc. CurrentSince May 1, 2005 Accepting new patients
Group Health, Inc. Current Accepting new patients

Locations

14701 Victor Hugo Blvd N
Hugo, MN 55038
Phone (651) 426-1141

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

2831 Snelling Ave N
Saint Paul, MN 55113
Phone (651) 636-4525

404 Highway 96 W
Shoreview, MN 55126
Phone (651) 482-8080

Interoperability endpoints

  • Direct secure messaging: anottleson23580@direct.healthpartners.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 12

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": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604361600000",
    "number": "1295700854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554254516",
            "telephone_number": "952-967-6620",
            "fax_number": "651-765-5901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2831 SNELLING AVE N",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131712",
            "telephone_number": "651-765-5900",
            "fax_number": "651-765-5901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOTTLESON",
        "first_name": "ANDREW",
        "middle_name": "N",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "38038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165213300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MN

Sources for this page

Verify at the official NPI Registry.