Individual provider Active NPI

Jessica Magruder, MD

  • Emergency Medicine Physician
  • St Louis Park, MN
National Provider Identifier
1558338715
Registry record updated Mar 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
45575 Issued in MN
Practice address
6500 Excelsior Blvd
Methodist Hospital
St Louis Park, MN 55426
Phone
(952) 993-6080
Fax
(952) 993-6047
NPI assigned
Mar 7, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 45575 MN Primary

Addresses

Primary practice location

6500 Excelsior Blvd
Methodist Hospital
St Louis Park, MN 55426

Mailing address

5435 Feltl Rd
Minnetonka, MN 55343-7983
Phone (952) 835-9880

Other identifiers 2

IdentifierTypeStateIssuer
697641700MedicaidMN
45575OtherMNMN MEDICAL LICENSE

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040127001065 MN Practitioner - Emergency Medicine 0547163701 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
94.23
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
45575MNMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians Professional Association CurrentSince Jul 1, 2003 Accepting new patients
Emergency Physicians Professional Association Emergency Medicine Current Accepting new patients
Emergency Physicians Professional Association CurrentSince Jul 1, 2003 Accepting new patients

Locations

4300 Marketpointe Dr
Ste 100
Minneapolis, MN 55435
Phone (952) 767-4574

5435 Feltl Rd
Minnetonka, MN 55343
Phone (952) 857-1504

6500 Excelsior Blvd
St Louis Park, MN 55426
Phone (952) 993-3246

Organizations & group practices 3

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": "1141689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269561600000",
    "number": "1558338715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5435 FELTL RD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553437983",
            "telephone_number": "952-835-9880",
            "fax_number": "952-857-1554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 EXCELSIOR BLVD",
            "address_2": "METHODIST HOSPITAL",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "55426",
            "telephone_number": "952-993-6080",
            "fax_number": "952-993-6047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAGRUDER",
        "first_name": "JESSICA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-07",
        "last_updated": "2010-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "45575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "697641700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN MEDICAL LICENSE",
            "identifier": "45575",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.