NPIMap

Individual provider Active NPI

Todd Edward Jackman, MD

  • Orthopaedic Surgery of the Spine Physician
  • Edina, MN
National Provider Identifier
1427259191
Registry record updated Jan 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
47215 Issued in MN
Practice address
7373 France Ave S Ste 408
Edina, MN 55435-4549
Phone
(651) 430-3800
Fax
(651) 430-3827
NPI assigned
May 30, 2007
Last updated
Jan 11, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery of the Spine Physician 207XS0117X 47215 MN Primary
Orthopaedic Surgery of the Spine Physician 207XS0117X MD00049377 WA

Addresses

Primary practice location

7373 France Ave S Ste 408
Edina, MN 55435-4549

Mailing address

1950 Northwestern Ave S Ste 102
Stillwater, MN 55082-7615
Phone (651) 430-3800

Other identifiers 4

IdentifierTypeStateIssuer
G8876642OtherWAMEDICARE EMRI
P00689386OtherWAMEDICARE RR KING CO.
G8876017OtherWAMEDICARE POSM
0238823OtherWAL & I

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address credentialing@midwestspine.net Other Midwest Spine & Brain Institute, L.L.C.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WA, WI3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20050601000903 MN Practitioner - Orthopedic Surgery 0143262022 Reassigns benefits to 4 organizations
I20081007000583 WA Practitioner - Orthopedic Surgery 0143262022 Reassigns benefits to 1 organization
I20220707002850 WI Practitioner - Orthopedic Surgery 0143262022 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Oregon Health Sciences University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Croix Regional Medical CenterGroup PAC ID 9335032184, 131 clinicians
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians
North Memorial Health CareGroup PAC ID 0042123028, 502 clinicians
Midwest Spine and Brain Institute LLCGroup PAC ID 4183613557, 5 clinicians

Practice addresses (Care Compare)

12375 Lindstrom LN
Lindstrom, MN 55045-9551
Phone (651) 400-2240

235 E State St
Saint Croix Falls, WI 54024-4117
Phone (715) 483-3221

280 Smith Ave N
Suite 600
Saint Paul, MN 55102-2446
Phone (651) 241-7246

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 863-4000

3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone (763) 520-4897

333 Smith Ave N
Saint Paul, MN 55102-2344
Phone (651) 241-8000

7373 France Ave S
Suite 408
Edina, MN 55435-4549
Phone (651) 430-3800

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion80
Laminectomy or laminotomy (partial removal of spine bones)26

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
47215MNMDOrthopaedic Surgery of the Spine Physician
MD00049377WAMDOrthopaedic Surgery of the Spine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons, Inc., P.S. CurrentSince Jul 1, 2008 Accepting new patients
Allina Health System CurrentSince Mar 1, 2021 Accepting new patients
North Memorial Health Care CurrentSince Mar 1, 2023 Accepting new patients
Proliance Surgeons Inc P S Orthopaedic Surgery of the Spine Current Accepting new patients
St. Croix Regional Medical Center CurrentSince Aug 15, 2022 Accepting new patients
Allina Health System CurrentSince Mar 1, 2021 Accepting new patients
Allina Health System Current Accepting new patients
St. Croix Regional Medical Center CurrentSince Aug 15, 2022 Accepting new patients
North Memorial Health Care Current Accepting new patients
Midwest Spine & Brain Institute, L.L.C. Orthopaedic Surgery of the Spine CurrentSince Mar 1, 2021 Accepting new patients
Proliance Surgeons Inc P S CurrentSince Jul 1, 2008 Accepting new patients
North Memorial Health Care CurrentSince Mar 1, 2023 Accepting new patients
North Memorial Health Care Past Accepting new patients
Allina Health System Past Accepting new patients

Locations

7270 Forestview Ln N
Ste 100
Maple Grove, MN 55369

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

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

7373 France Ave S
Ste 408
Minneapolis, MN 55435
Phone (952) 831-8228

3366 Oakdale Ave N
Ste 200
Robbinsdale, MN 55422
Phone (763) 287-5000

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

1950 Northwestern Ave S
Ste 102
Stillwater, MN 55082
Phone (651) 259-4515

1950 Curve Crest Blvd W
Ste 10
Stillwater, MN 55082

1231 116th Ave NE
Ste 750
Bellevue, WA 98004
Phone (425) 455-3600

510 8th Ave NE
Ste 200
Issaquah, WA 98029
Phone (425) 392-3030

12911 120th Ave NE
Ste H120
Kirkland, WA 98034
Phone (425) 823-4226

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

2651 Hillcrest Dr
Hudson, WI 54016
Phone (630) 632-2648

525 N Knowles Ave
#200
New Richmond, WI 54017
Phone (715) 483-1785

216 S Adams St
St Croix Fls, WI 54024
Phone (715) 483-0426

235 E State St
St Croix Fls, WI 54024
Phone (715) 483-3221

Interoperability endpoints

  • Direct secure messaging: tjackman159397@excellian.direct.allina.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: todd.jackmanmd.p1@direct.midwestspinebrain.nextgenshare.com
  • Direct secure messaging: tjackman190816@direct.northmemorial.com

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1427259191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 NORTHWESTERN AVE S STE 102",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550827615",
            "telephone_number": "651-430-3800",
            "fax_number": "651-430-3827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7373 FRANCE AVE S STE 408",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354549",
            "telephone_number": "651-430-3800",
            "fax_number": "651-430-3827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKMAN",
        "first_name": "TODD",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-30",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "MN",
            "license": "47215",
            "primary": true
        },
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "WA",
            "license": "MD00049377",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE EMRI",
            "identifier": "G8876642",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR KING CO.",
            "identifier": "P00689386",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE POSM",
            "identifier": "G8876017",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "0238823",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "credentialing@midwestspine.net",
            "affiliation": "Y",
            "affiliationName": "Midwest Spine & Brain Institute, L.L.C.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "credentialing",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "1950 Northwestern Ave S Ste 102",
            "city": "Stillwater",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550827615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.