Active NPI
Jacob Forsythe, CNP
- Acute Care Nurse Practitioner
- Maple Grove, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- 10145
- Practice address
- 9645 Grove Cir N Ste 200
Maple Grove, MN 55369-2684 - Phone
- (763) 201-8191
- Fax
- (763) 201-8192
- NPI assigned
- Jul 10, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 10145 | MN | Primary |
Addresses
Primary practice location
9645 Grove Cir N Ste 200
Maple Grove, MN 55369-2684
Mailing address
9645 Grove Cir N Ste 200
Maple Grove, MN 55369-2684
Phone (763) 201-8191
Medicare participation
Medicare enrollment files- 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: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3000 Hundertmark Rd
Suite 250
Chaska, MN 55318-2729
Phone (763) 201-8191
Hospital & facility affiliations
- Ridgeview Medical Center
- Abbott Northwestern Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Interventional Spine and Pain Physicians, PA | Current | Accepting new patients | |
| Anesthesia Associates, PLLC | Past | Accepting new patients |
Locations
3000 Hundertmark Rd
Ste 250
Chaska, MN 55318
Phone (507) 625-7246
916 Saint Peter Ave E
Delano, MN 55328
Phone (763) 972-9172
7700 France Ave S
Ste 260
Edina, MN 55435
9600 Upland Ln N
Ste 160
Maple Grove, MN 55369
9645 Grove Cir N
Ste 200
Maple Grove, MN 55369
Phone (763) 300-2193
Organizations & group practices 2
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.
-
- Specialist
- Maple Grove, MN
- NPI 1326398561
-
- Specialist
- Maple Grove, MN
- NPI 1104176205
Hospital & facility affiliations 25
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Obesity Medicine (Family Medicine) Physician
- Minneapolis, MN
- NPI 1154684835
Hospital
-
- Physical Medicine & Rehabilitation Physician
- Minneapolis, MN
- NPI 1275577215
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1688947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701388800000",
"number": "1487332375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9645 GROVE CIR N STE 200",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553692684",
"telephone_number": "763-201-8191",
"fax_number": "763-201-8192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9645 GROVE CIR N STE 200",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553692684",
"telephone_number": "763-201-8191",
"fax_number": "763-201-8192"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORSYTHE",
"first_name": "JACOB",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-07-10",
"last_updated": "2023-12-01",
"certification_date": "2023-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "MN",
"license": "10145",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maple Grove, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; 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.