Active NPI
Lawrence Thomas Mollo, MD
- Pediatrics Physician
- Champlin, MN
National Provider Identifier
1508122334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 62157
- Practice address
- 12142 Business Park Blvd N
Champlin, MN 55316-4525 - Phone
- (952) 977-0500
- NPI assigned
- Apr 5, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 62157 | MN | |
| Internal Medicine Physician | 207R00000X | 125061609 | IL | |
| Pediatrics Physician | 208000000X | 125061609 | IL | |
| Pediatrics Physician | 208000000X | 62157 | MN | Primary |
Addresses
Primary practice location
12142 Business Park Blvd N
Champlin, MN 55316-4525
Mailing address
2160 S 1St Ave
RM 7609
Maywood, IL 60153-3328
Phone (708) 216-8757
Other practice location 1
2160 S 1st Ave
Rm 7609
Maywood, IL 60153-3328
Phone (708) 216-8757
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Pediatric Medicine
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
12142 Business Park Blvd N
Champlin, MN 55316-4525
Phone (952) 977-0500
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125061609 | IL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Nicollet Clinic | Pediatrics | Current | Accepting new patients |
| Park Nicollet Clinic | Pediatrics | Current | Accepting new patients |
| Park Nicollet Clinic | Pediatrics | Current | Accepting new patients |
Locations
12142 Business Park Blvd N
Champlin, MN 55316
Phone (952) 977-0500
9555 Upland Ln N
Maple Grove, MN 55369
Phone (952) 993-1440
5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400
3800 Park Nicollet Blvd
St Louis Park, MN 55416
Phone (952) 993-1000
Interoperability endpoints
- lmollo226712@direct.healthpartners.com
Organizations & group practices 3
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.
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Maple Grove, MN
- NPI 1174980692
-
- General Acute Care Hospital
- St Louis Park, MN
- NPI 1194113217
-
- General Acute Care Hospital
- St Louis Park, MN
- NPI 1245615772
-
- Mental Illness Community Based Residential Treatment Facility
- St Louis Park, MN
- NPI 1578717336
Hospital
-
- General Acute Care Hospital
- St Louis Park, MN
- NPI 1649220724
-
- General Acute Care Hospital
- St Louis Park, MN
- NPI 1942585286
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1333584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1508122334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2160 S 1ST AVE",
"address_2": "RM 7609",
"city": "MAYWOOD",
"state": "IL",
"postal_code": "601533328",
"telephone_number": "708-216-8757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12142 BUSINESS PARK BLVD N",
"city": "CHAMPLIN",
"state": "MN",
"postal_code": "553164525",
"telephone_number": "952-977-0500"
}
],
"practiceLocations": [
{
"address_1": "2160 S 1st Ave",
"address_2": "Rm 7609",
"address_purpose": "LOCATION",
"city": "Maywood",
"state": "IL",
"postal_code": "601533328",
"country_code": "US",
"telephone_number": "708-216-8757",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOLLO",
"first_name": "LAWRENCE",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-04-05",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MN",
"license": "62157",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "125061609",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "125061609",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "62157",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Champlin, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.