Randal Nelson, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9982 Issued in MN

Practice address

2355 Highway 36 W
Ste 100
Roseville, MN 55113-3905

Phone

(651) 292-2000

NPI assigned

Aug 17, 2006

Last updated

Jul 20, 2021By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Consulting Radiologists, LTD

  • Diagnostic Radiology Physician
  • Eden Prairie, MN
  • NPI 1487730594
  NPD (past)

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1558474197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2355 HIGHWAY 36 W",
            "address_2": "STE 100",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133905",
            "telephone_number": "651-292-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2355 HIGHWAY 36 W",
            "address_2": "STE 100",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133905",
            "telephone_number": "651-292-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9055 Springbrook Dr NW",
            "address_purpose": "LOCATION",
            "city": "Coon Rapids",
            "state": "MN",
            "postal_code": "554335841",
            "country_code": "US",
            "telephone_number": "763-780-9155",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4801 W 81st St",
            "address_2": "Suite 108",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "MN",
            "postal_code": "554371111",
            "country_code": "US",
            "telephone_number": "952-837-9700",
            "fax_number": "952-837-9701",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "250 Thompson St",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551022370",
            "country_code": "US",
            "telephone_number": "651-292-2000",
            "fax_number": "651-292-2136",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "RANDAL",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "970002312",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karl T Nelsen, P.A.
• Brian W Nelson, MD
• Brianna Nelson
• Justin Nelson, M.D.
• Nicole Marie Nelson, PHARM.D.
• Nest Care Services LLC (Nest Care Homes)
• Neve Inc (Avada Audiology & Hearing Care)
• Sameer Nevile, M.D.
• New Leaf Therapy, Inc.
• Bailey Newell, MA, LMFT

• Physician Assistant in Roseville, MN
• Providers in Roseville, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.