NPIMap

Organization Active NPI

Park Nicollet Clinic

  • Family Medicine Physician
  • Brooklyn Park, MN
National Provider Identifier
1447668678
Registry record updated Oct 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PARK NICOLLET CLINIC
Practice address
7000 Target Pkwy N
Brooklyn Park, MN 55445-4301
Phone
(952) 977-1985
NPI assigned
Jul 31, 2014
Last updated
Oct 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2021

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

Authorized official

Name
Jason James Luhrs
Title
VP Finance
Phone
(952) 883-7158

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X
Family Medicine Physician 207Q00000X Primary
Obstetrics & Gynecology Physician 207V00000X
Pediatrics Physician 208000000X

Addresses

Primary practice location

7000 Target Pkwy N
Brooklyn Park, MN 55445-4301

Mailing address

3800 Park Nicollet Blvd
Attention: Business Services
St Louis Park, MN 55416-2527
Phone (952) 993-1000

Other names 1

  • HEALTH & WELL-BEING CENTER Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031104000046 MN Part B Supplier - Clinic/Group Practice 7911819438 Receives reassigned benefits from 2,728 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Minneapolis, MN; Shakopee, MN; Minnetonka, MN; Plymouth, MN; Prior Lake, MN; Rogers, MN; Saint Paul, MN; St Louis Park, MN…

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2080813Park Nicollet - Target Clinic North7000 Target Parkway North, Brooklyn Park, MN 55445Certificate of waiverJul 14, 2026

National Provider Directory

National Provider Directory
Tax ID family
Park Nicollet Clinic6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

1885 Plaza Dr
Saint Paul, MN 55122
Phone (952) 993-4001

1415 Saint Francis Ave
Shakopee, MN 55379
Phone (952) 993-7750

3850 Park Nicollet Blvd
St Louis Park, MN 55416
Phone (952) 883-1000

Practitioners & affiliated clinicians

Practitioners 447

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 447

NPI Registry JSON

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

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635120000000",
    "number": "1447668678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 PARK NICOLLET BLVD",
            "address_2": "ATTENTION: BUSINESS SERVICES",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162527",
            "telephone_number": "952-993-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7000 TARGET PKWY N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554454301",
            "telephone_number": "952-977-1985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK NICOLLET CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-31",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A",
        "authorized_official_last_name": "LUHRS",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "952-883-7158"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HEALTH & WELL-BEING CENTER",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "HEALTH & WELL-BEING CENTER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Brooklyn Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.