Pain Specialist of Minnesota

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

PAIN SPECIALIST OF MINNESOTA

Practice address

5810 Excelsior Blvd
St Louis Park, MN 55416-2830

Phone

(612) 235-6008

Fax

(612) 235-6003

NPI assigned

Feb 3, 2023

Organization subpart

No

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

Authorized official

Name

Mark StockNPI 1962634154

Title

Ceo

Phone

(651) 238-8580

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Stock, NP-C

  • Family Nurse Practitioner
  • St Louis Park, MN
  • NPI 1962634154
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1675382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1508562240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5810 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162830",
            "telephone_number": "612-235-6008",
            "fax_number": "612-235-6003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5810 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162830",
            "telephone_number": "612-235-6008",
            "fax_number": "612-235-6003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN SPECIALIST OF MINNESOTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-03",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A",
        "authorized_official_last_name": "STOCK",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "651-238-8580"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Louise Page, L.P.C.C.
• Laura Pagel
• Nicole Marie Pagel, DO
• Michelle Maureen Pahl, MA, LMFT
• Gautam K Pai
• Tawatchai Paisansinsup
• Jongsok Pak, M.D.
• Patrick James Palan, L.C.S.W.
• Lisa N Palmen, CRNA
• Christopher Mark Palmer, A.T.,C.

• Family Nurse Practitioner in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; 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.