NPIMap

Individual provider Active NPI

Shelly Lea Larson-Peters, M.D.

  • Neurology Physician
  • Blaine, MN
National Provider Identifier
1336333509
Registry record updated Jul 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
50897 Issued in MN
Practice address
11091 Ulysses St
Suite 100
Blaine, MN 55434-4238
Phone
(612) 879-1000
Fax
(612) 879-9116
NPI assigned
Aug 30, 2007
Last updated
Jul 30, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 50897 MN Primary

Addresses

Primary practice location

11091 Ulysses St
Suite 100
Blaine, MN 55434-4238

Mailing address

3601 Minnesota Dr Ste 200
Bloomington, MN 55435-5281
Phone (612) 879-1000

Other names 1

  • Shelly Lea Larson Former name

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
I20091015000104 MN Practitioner - Neurology 0042356479 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Minneapolis Clinic of Neurology LTDGroup PAC ID 5496668659, 75 clinicians
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians

Practice addresses (Care Compare)

3833 Coon Rapids Blvd NW
Suite 100
Coon Rapids, MN 55433-2697
Phone (763) 427-8320

800 E 28TH St
Suite H2100
Minneapolis, MN 55407-3723
Phone (612) 863-3900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Oct 10, 2016 Accepting new patients
Allina Health System Current Accepting new patients
Noran Neurological Clinic P.a. CurrentSince Oct 10, 2016 Accepting new patients
Allina Health System CurrentSince Oct 10, 2016 Accepting new patients
Minneapolis Clinic of Neurology, LTD Neurology CurrentSince Jun 23, 2025 Accepting new patients
Quest Diagnostics LLC Il Past Accepting new patients

Locations

11091 Ulysses St NE
Ste 100
Blaine, MN 55434
Phone (763) 783-3377

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

2828 Chicago Ave
Ste 200
Minneapolis, MN 55407
Phone 61287910001502

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

3601 Minnesota Dr
Ste 200
Minneapolis, MN 55435
Phone (952) 992-5691

3833 Coon Rapids Blvd NW
Ste 100
Minneapolis, MN 55433
Phone (763) 427-8320

4225 Golden Valley Rd
Minneapolis, MN 55422
Phone (612) 588-0661

800 E 28th St
Ste H2100
Minneapolis, MN 55407
Phone (612) 863-3900

2855 Campus Dr
Ste 570
Plymouth, MN 55441
Phone (763) 553-2073

Interoperability endpoints

  • Direct secure messaging: shellylarsonpeters@direct.noranclinic.com
  • Direct secure messaging: slarsonpeters213838@direct.northmemorial.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1188432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690675200000",
    "number": "1336333509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 MINNESOTA DR STE 200",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554355281",
            "telephone_number": "612-879-1000",
            "fax_number": "612-879-9116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11091 ULYSSES ST",
            "address_2": "SUITE 100",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554344238",
            "telephone_number": "612-879-1000",
            "fax_number": "612-879-9116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON-PETERS",
        "first_name": "SHELLY",
        "middle_name": "LEA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-30",
        "last_updated": "2023-07-30",
        "certification_date": "2023-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MN",
            "license": "50897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLY",
            "last_name": "LARSON",
            "middle_name": "LEA",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Blaine, MN

Sources for this page

Verify at the official NPI Registry.