NPIMap

Individual provider Active NPI

Madeline Nicole Debol, PA

  • Physician Assistant
  • St Louis Park, MN
National Provider Identifier
1508424102
Registry record updated Sep 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13102 Issued in MN
Practice address
3931 Louisiana Ave S
St Louis Park, MN 55426-5000
Phone
(952) 993-3231
NPI assigned
May 30, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 13102 MN Primary

Addresses

Primary practice location

3931 Louisiana Ave S
St Louis Park, MN 55426-5000

Mailing address

8170 33Rd Ave S # Ms 21110Q
Bloomington, MN 55425-4516

Other practice location 1

500 Harvard St SE
Minneapolis, MN 55455-0363
Phone (952) 270-2272

Other names 1

  • Ms. Madeline Nicole Johnson Former name

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
I20190820004103 MN Practitioner - Physician Assistant 8325376924 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-3123

Hospital & facility affiliations

  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053

Merit-based Incentive Payment System (MIPS)

Final score
88.63 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services CurrentSince Aug 30, 2019 Accepting new patients
Fairview Health Services CurrentSince Aug 30, 2019 Accepting new patients
Fairview Clinics CurrentSince Sep 10, 2019 Accepting new patients
Fairview Clinics CurrentSince Sep 10, 2019 Accepting new patients
Fairview Express Care CurrentSince Oct 9, 2019 Accepting new patients
Fairview Express Care CurrentSince Oct 9, 2019 Accepting new patients
Park Nicollet Clinic CurrentSince Sep 23, 2024 Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

3931 Louisiana Ave S
St Louis Park, MN 55426
Phone (952) 993-3230

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1559174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1508424102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3931 LOUISIANA AVE S",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554265000",
            "telephone_number": "952-993-3231"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Harvard St SE",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554550363",
            "country_code": "US",
            "telephone_number": "952-270-2272",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEBOL",
        "first_name": "MADELINE",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-30",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MADELINE",
            "last_name": "JOHNSON",
            "middle_name": "NICOLE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.