NPIMap

Organization Active NPI

Park Nicollet Health Care Products

  • Durable Medical Equipment & Medical Supplies
  • Shakopee, MN
National Provider Identifier
1487105995
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PARK NICOLLET HEALTH CARE PRODUCTS
Practice address
1455 Saint Francis Ave
Shakopee, MN 55379-3374
Phone
(952) 993-7644
Fax
(952) 993-0562
NPI assigned
Oct 19, 2016
Last updated
Nov 7, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
PARK NICOLLETAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Authorized official

Name
Kristin D Brey
Title
Supervisor/Delegated Official
Phone
(952) 993-6832

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X MN Primary

Addresses

Primary practice location

1455 Saint Francis Ave
Shakopee, MN 55379-3374

Mailing address

3800 Park Nicollet Blvd # Ms 61901C
St Louis Park, MN 55416-2527

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180924000936 MN DME Supplier - Medical Supply CompanyDME Supplier - Optician 2365655164 Practice locations: Shakopee, MN

Other NPIs with the same Medicare PAC ID 9

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

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Park Nicollet Health Care Products1455 Saint Francis Ave, Shakopee, MN 55379-3374(952) 993-7644 Commodes, Urinals, Bedpans|Traction Equipment|Ultraviolet Light Devices and/or Supplies|Canes and/or Crutches|Walkers|Orthoses: Off-The-Shelf|Ostomy Supplies|Urological Supplies|Continuous Positive Airway Pressure (CPAP) Devices|Nebulizer Equipment and/or Supplies|Surgical Dressings|Lymphedema Comp… Does not accept assignmentParticipating since Jul 1, 2002

National Provider Directory

National Provider Directory
Tax ID family
Park Nicollet10 organizations share this tax ID, including this one
Part of
Park Nicollet Methodist Hospital

Other organizations with this tax ID 9

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

Locations

1455 Saint Francis Ave
Shakopee, MN 55379
Phone (952) 403-2200

3800 Park Nicollet Blvd
#3
St Louis Park, MN 55416

NPI Registry JSON

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1487105995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 PARK NICOLLET BLVD # MS 61901C",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162527",
            "fax_number": "952-993-0562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 SAINT FRANCIS AVE",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553793374",
            "telephone_number": "952-993-7644",
            "fax_number": "952-993-0562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK NICOLLET HEALTH CARE PRODUCTS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PARK NICOLLET",
        "enumeration_date": "2016-10-19",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "BREY",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "SUPERVISOR/DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "952-993-6832"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shakopee, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; 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.