NPIMap

Individual provider Active NPI

McKenzie Brace

  • Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1508416579
Registry record updated Aug 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
8342 Issued in MN
Practice address
2820 Inglewood Ave S
Minneapolis, MN 55416-4112
Phone
(914) 589-5503
Fax
(763) 465-0588
NPI assigned
Sep 12, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 8342 MN Primary
Cardiac Rehabilitation Registered Nurse 163WC3500X 2375351 MN

Addresses

Primary practice location

2820 Inglewood Ave S
Minneapolis, MN 55416-4112

Mailing address

3243 Fillmore St NE
Minneapolis, MN 55418-2152
Phone (319) 939-8354

Other identifiers 1

IdentifierTypeStateIssuer
2375351OtherMNRN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210813003233 MN Practitioner - Nurse Practitioner 1254735111 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Minnesota Medical School, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aeris Medical Group PLLCGroup PAC ID 0042624306, 26 clinicians

Practice addresses (Care Compare)

St Louis Park, MN 55416
Phone (914) 589-5503

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2375351MNMDCardiac Rehabilitation Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Aeris Medical Group PLLC CurrentSince Aug 16, 2021 Accepting new patients
Aeris Care Network PLLC Current Accepting new patients
Provider Partners Care Management LP Nurse Practitioner CurrentSince Aug 1, 2025 Accepting new patients

Locations

8820 Columbia 100 Pkwy
Ste 430
Columbia, MD 21045
Phone (410) 967-2097

800 2nd Ave NW
Plainview, MN 55964
Phone (507) 534-3191

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 10

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

NPI Registry JSON

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

{
    "created_epoch": "1568246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627948800000",
    "number": "1508416579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3243 FILLMORE ST NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554182152",
            "telephone_number": "319-939-8354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 INGLEWOOD AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554164112",
            "telephone_number": "914-589-5503",
            "fax_number": "763-465-0588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACE",
        "first_name": "MCKENZIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-12",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "8342",
            "primary": true
        },
        {
            "code": "163WC3500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Cardiac Rehabilitation",
            "state": "MN",
            "license": "2375351",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN",
            "identifier": "2375351",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.