NPIMap

Activstyle, LLC

Organization Active NPI Durable Medical Equipment & Medical Supplies · Saint Paul, MN

NPI 1417954165 · NPPES record last updated Nov 13, 2025

Key facts

NPI
1417954165
Entity type
Organization (NPI type 2)
Primary specialty
Durable Medical Equipment & Medical Supplies 332B00000X
Legal business name
ACTIVSTYLE, LLC
Practice address
1055 Westgate Dr Ste 100
Saint Paul, MN 55114-1451
Phone
(800) 651-6223
Fax
(866) 896-7171
NPI assigned
Jul 7, 2005
Organization subpart
Yes
Parent organization (as reported)
ACTIVSTYLE HOLDING COMPANY

Authorized official

Name
Darrell Douglas Rawlings
Title
Ceo
Phone
(612) 895-7815

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 5

Organizations that report the same tax identification number in the National Provider Directory.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Activstyle LLC
1055 Westgate Dr, Saint Paul, MN 55114-1451 · (651) 760-7275		 Commodes, Urinals, Bedpans|Ostomy Supplies|Urological Supplies|Enteral Nutrients|Enteral Equipment and/or Supplies|Surgical Dressings Accepts assignment
Participating since Jan 1, 2013

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MN

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100930028427 MN DME Supplier - Medical Supply Company 1951422302 Practice locations: Saint Paul, MN

National Provider Directory

Tax ID family
Activstyle LLC (6 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Yes
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X

Addresses

Primary practice location

1055 Westgate Dr Ste 100
Saint Paul, MN 55114-1451

Mailing address

1055 Westgate Dr Ste 100
Saint Paul, MN 55114-1451
Phone (800) 651-6223

Other identifiers

IdentifierTypeStateIssuer
34951725MedicaidCO
9059163MedicaidWA
1013449MedicaidVT
101373387MedicaidVA
1021830MedicaidAK
200219460 AMedicaidIN
1409928MedicaidLA
1417954165MedicaidIA
4582469MedicaidTN
014083000MedicaidMD
200106290AMedicaidOK
2227423MedicaidOH
54456MedicaidND
807670400MedicaidID
004268844MedicaidCT
101858880 0002MedicaidPA
166866MedicaidAL
5720001MedicaidRI
596546MedicaidHI
1417954165MedicaidMN
0048074MedicaidMT
183206MedicaidAZ
84532017MedicaidNM
124008100MedicaidWY

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 13, 2025.

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762992000000",
    "number": "1417954165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 WESTGATE DR STE 100",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141451",
            "telephone_number": "800-651-6223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 WESTGATE DR STE 100",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141451",
            "telephone_number": "800-651-6223",
            "fax_number": "866-896-7171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVSTYLE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ACTIVSTYLE HOLDING COMPANY",
        "enumeration_date": "2005-07-07",
        "last_updated": "2025-11-13",
        "certification_date": "2025-11-13",
        "status": "A",
        "authorized_official_last_name": "RAWLINGS",
        "authorized_official_first_name": "DARRELL",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "612-895-7815"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34951725",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9059163",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013449",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101373387",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1021830",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200219460 A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1409928",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417954165",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4582469",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014083000",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200106290A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2227423",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54456",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807670400",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004268844",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101858880 0002",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166866",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5720001",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "596546",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417954165",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0048074",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "183206",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "84532017",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124008100",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

All providers in Saint Paul, MN · Durable Medical Equipment & Medical Supplies in Minnesota

Sources for this page

Verify at the official NPI Registry.