Tristan Pennella, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

73409 Issued in MN

Practice address

675 Water St
Excelsior, MN 55331-3158

Phone

(952) 906-7855

NPI assigned

Apr 28, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Des Moines University of Osteopathic Medicine and Health Sciences, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ridgeview Medical CenterGroup PAC ID 9234041997, 407 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ridgeview Medical Center Hospital, Waconia, MN, CCN 240056

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Ridgeview Medical Center

  dba Ridgeview Medical Center CRNAs

  • Certified Registered Nurse Anesthetist
  • Waconia, MN
  • NPI 1528364429

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Minnesota Valley Health Center Inc

  • Critical Access Hospital
  • Le Sueur, MN
  • NPI 1730248907

  Single Specialty

  Medicare reassignment NPD
• Sibley Medical Center

  dba Ridgeview Sibley Medical Center

  • Critical Access Hospital
  • Arlington, MN
  • NPI 1740240225

  Single Specialty

  Medicare reassignment NPD
• Minnesota Valley Health Center Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Le Sueur, MN
  • NPI 1215097902
  NPD
• Ridgeview Medical Center

  • Urgent Care Clinic/Center
  • Chanhassen, MN
  • NPI 1558142869
  NPD
• Ridgeview Medical Center

  • Diagnostic Radiology Physician
  • Waconia, MN
  • NPI 1811174923

  Single Specialty

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ridgeview Medical Center

  • General Acute Care Hospital
  • Waconia, MN
  • NPI 1275608457
  Care Compare affiliation
• Ridgeview Medical Center

  • General Acute Care Hospital
  • Chaska, MN
  • NPI 1710748538
  Care Compare affiliation

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

{
    "created_epoch": "1619568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1356923361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 WATER ST",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553313158",
            "telephone_number": "952-906-7855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 WATER ST",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553313158",
            "telephone_number": "952-906-7855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNELLA",
        "first_name": "TRISTAN",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-28",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "73409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Omann, DC
• Axel David Osborn, DC
• Kayla Lynn Parker, CNP
• Kristen L Paulson, P.T.
• Brenda J Payne, CRNA
• Gina Orourke Peschel, PAC
• Jess Peters
• Kathleen Michelle Petersen, PHD
• Paige Pickard
• Carrie L Pluemer, MA CCC-SLP

• Family Medicine Physician in Excelsior, MN
• Providers in Excelsior, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.