Individual provider Active NPI

Nina M Malm, APRN, CNP

  • Gerontology Nurse Practitioner
  • Rochester, MN
National Provider Identifier
1336562172
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
5629 Issued in MN
Practice address
5067 55TH St NW
Rochester, MN 55901-3809
Phone
(507) 292-7070
NPI assigned
Jan 30, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5655 WI
Adult Health Nurse Practitioner 363LA2200X 5655 WI
Gerontology Nurse Practitioner 363LG0600X 5655 WI
Gerontology Nurse Practitioner 363LG0600X 5629 MN Primary

Addresses

Primary practice location

5067 55TH St NW
Rochester, MN 55901-3809

Mailing address

5067 55TH St NW
Rochester, MN 55901-3809
Phone (507) 292-7070

Other practice location 1

130 2nd St
Neenah, WI 54956-2883
Phone (920) 725-0077

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20140401001593 WI Practitioner - Nurse Practitioner 5799916953 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aspirus Wausau Hospital IncGroup PAC ID 6406757442, 242 clinicians

Practice addresses (Care Compare)

425 Pine Ridge Blvd
Wausau, WI 54401-4123
Phone (715) 843-1067

Hospital & facility affiliations

  • Aspirus Wausau Hospital Hospital, Wausau, WI, CCN 520030

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5629MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Wausau Hospital, Inc. Current Accepting new patients
Thedacare, Incorporated CurrentSince Feb 2, 2014 Accepting new patients
Matrix Medical Plus Nurse Practitioner CurrentSince Oct 1, 2024 Accepting new patients
Aspirus Wausau Hospital Inc CurrentSince Dec 17, 2024 Accepting new patients
Aspirus Wausau Hospital, Inc. CurrentSince Dec 17, 2024 Accepting new patients
Aspirus Medical Group, Inc. Past Accepting new patients

Locations

9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883

29980 Network Pl
Chicago, IL 60673

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

250 E Wisconsin Ave
Fl 18
Milwaukee, WI 53202
Phone (303) 748-5781

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

425 Pine Ridge Blvd
Wausau, WI 54401
Phone (715) 847-2400

333 Pine Ridge Blvd
Wausau, WI 54401
Phone (715) 847-2160

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 and National Provider Directory roles.

Hospital & facility affiliations 10

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": "1391040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1336562172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5067 55TH ST NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559013809",
            "telephone_number": "507-292-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5067 55TH ST NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559013809",
            "telephone_number": "507-292-7070"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "130 2nd St",
            "address_purpose": "LOCATION",
            "city": "Neenah",
            "state": "WI",
            "postal_code": "549562883",
            "country_code": "US",
            "telephone_number": "920-725-0077",
            "fax_number": "920-725-6535",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALM",
        "first_name": "NINA",
        "middle_name": "M",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-30",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "5655",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WI",
            "license": "5655",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "WI",
            "license": "5655",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "5629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, MN

Sources for this page

Verify at the official NPI Registry.