Gary Alan Nisius, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

41693 Issued in MN

Practice address

15655 37TH Ave N Ste 100
Plymouth, MN 55446-4003

Phone

(763) 587-7900

Fax

(763) 587-7701

NPI assigned

Jun 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Minnesota Medical School, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Clinic PAGroup PAC ID 2769384205, 50 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• North Memorial Health Hospital Hospital, Robbinsdale, MN, CCN 240001

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• North Clinic, PA

  • Family Medicine Physician
  • Brooklyn Park, MN
  • NPI 1114962206
  Medicare reassignment Care Compare group NPD
• North Memorial Health Care

  • General Acute Care Hospital
  • Robbinsdale, MN
  • NPI 1851344907
  Medicare reassignment NPD
• North Clinic, PA

  • Multi-Specialty Clinic/Center
  • Brooklyn Park, MN
  • NPI 1407011760

  Family Medicine

  NPD
• North Memorial Health Care

  • Hospitalist Physician
  • Robbinsdale, MN
  • NPI 1518983634
  NPD
• North Memorial Health Care

  • Clinic/Center
  • Blaine, MN
  • NPI 1841995552
  NPD

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

• North Memorial Health Care

  • Ambulance
  • Brooklyn Center, MN
  • NPI 1538195912

  Hospital

  Care Compare affiliation
• North Memorial Health Care

  • Medical Specialty Clinic/Center
  • Robbinsdale, MN
  • NPI 1699953000

  Hospital

  Care Compare affiliation
• North Memorial Health Care

  • Clinic/Center
  • Blaine, MN
  • NPI 1841995552

  Hospital

  Care Compare affiliation
• North Memorial Health Care

  • General Acute Care Hospital
  • Robbinsdale, MN
  • NPI 1851344907
  Care Compare affiliation

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1518995042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9201 W BROADWAY AVE STE 601",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554451924",
            "telephone_number": "763-587-7900",
            "fax_number": "763-587-7066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15655 37TH AVE N STE 100",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554464003",
            "telephone_number": "763-587-7900",
            "fax_number": "763-587-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISIUS",
        "first_name": "GARY",
        "middle_name": "ALAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "41693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "940521600",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gary.nisius@nor.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "15655 37th Ave N",
            "address_2": "Suite 100",
            "city": "Plymouth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554463207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gary E. Nichols, M.D.
• Sierra Nichols, LMFT
• Molly O'Donnell Nicolai, SLP
• Sarah A Nicosia
• Margaret Nilson, AUD, CCC-A
• Noble Home Care Service
• Molly Nordberg
• Danielle Norgren
• Stephanie Norris, M.D.
• North Clinic, PA

• Family Medicine Physician in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 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.

Verify at the official NPI Registry.