Individual provider Active NPI

Lucas Neuburg, CNP

  • Pediatric Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1518555192
Registry record updated Jun 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
11366 Issued in MN
Practice address
2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone
(612) 365-6777
NPI assigned
Jan 8, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 11366 MN Primary

Addresses

Primary practice location

2450 Riverside Ave
Minneapolis, MN 55454-1450

Mailing address

2450 Riverside Ave Ste Code8951
Minneapolis, MN 55454-1450

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240405003608 MN Practitioner - Nurse Practitioner 2365880523 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

717 Delaware St SE
Suite 340
Minneapolis, MN 55414-2959
Phone (612) 672-7422

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Minnesota Physicians CurrentSince May 24, 2024 Accepting new patients
University of Minnesota Physicians Current Accepting new patients
University of Minnesota Health Clinics and Surgery Center, Inc. Current Accepting new patients
Fairview Express Care CurrentSince May 24, 2024 Accepting new patients
Fairview Express Care Current Accepting new patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince May 24, 2024 Accepting new patients
University of Minnesota Physicians CurrentSince May 24, 2024 Accepting new patients
Fairview Express Care CurrentSince May 24, 2024 Accepting new patients
Fairview Express Care Past Accepting new patients
Fairview Health Services Past Accepting new patients

Locations

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

516 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-3600

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

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

2450 Riverside Ave
Ste CODE8951
Minneapolis, MN 55454

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

2512 S 7th St
Fl 3
Minneapolis, MN 55454
Phone (612) 365-6777

2512 S 7th St
Ste 103
Minneapolis, MN 55454

2512 S 7th St
Minneapolis, MN 55454
Phone (612) 273-4277

Interoperability endpoints

  • Direct secure messaging: lneuburg923839@fairview.direct-ci.com

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1610064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718755200000",
    "number": "1518555192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE STE CODE8951",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-365-6777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEUBURG",
        "first_name": "LUCAS",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-08",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "11366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.