Individual provider Active NPI

Jonathan Stanley Popko, CNP

  • Family Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1558080929
Registry record updated Aug 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
9456 Issued in MN
Practice address
606 24TH Ave S Ste 602
Minneapolis, MN 55454-1438
Phone
(612) 672-2450
NPI assigned
Aug 26, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 9456 MN Primary

Addresses

Primary practice location

606 24TH Ave S Ste 602
Minneapolis, MN 55454-1438

Mailing address

3215 E 24TH St
Minneapolis, MN 55406-1405
Phone (612) 562-5880

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
I20220915000303 MN Practitioner - Nurse Practitioner 0840675666 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

1440 Duckwood Dr
Eagan, MN 55122-1451
Phone (651) 406-8860

2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone (612) 672-6000

600 W 98TH St
Bloomington, MN 55420-4773
Phone (952) 881-2651

606 24TH Ave S
Suite 700
Minneapolis, MN 55454-1455
Phone (612) 672-2450

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

Hospital & facility affiliations

  • M Health Fairview University of MN Medical Center Hospital, Minneapolis, MN, CCN 240080

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Clinics CurrentSince Aug 25, 2022 Accepting new patients
Fairview Clinics CurrentSince Aug 25, 2022 Accepting new patients
Fairview Clinics Multi-Specialty Current Accepting new patients
Fairview Clinics Past Accepting new patients

Locations

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

606 24th Ave S
Ste 602
Minneapolis, MN 55454
Phone (612) 273-6099

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

Organizations & group practices 4

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 3

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": "1661472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661472000000",
    "number": "1558080929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3215 E 24TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554061405",
            "telephone_number": "612-562-5880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 24TH AVE S STE 602",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541438",
            "telephone_number": "612-672-2450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POPKO",
        "first_name": "JONATHAN",
        "middle_name": "STANLEY",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-26",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "9456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.