Active NPI
Dominic J Marcuccio, PA
- Physician Assistant
- Bloomington, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 10548
- Practice address
- 4300 Marketpointe Dr Ste 100
Bloomington, MN 55435-5435 - Phone
- (952) 835-9880
- Fax
- (952) 857-1554
- NPI assigned
- Sep 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10548 | MN | Primary |
Addresses
Primary practice location
4300 Marketpointe Dr Ste 100
Bloomington, MN 55435-5435
Mailing address
4300 Marketpointe Dr Ste 100
Bloomington, MN 55435-5435
Phone (952) 835-9880
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41953200 | Medicaid | WI |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1159 County Rd E E
Vadnais Heights, MN 55110-5183
Phone (651) 789-6500
3010 Denmark Ave
Eagan, MN 55121-2271
Phone (651) 789-9900
4300 Marketpointe Dr
Suite 100
Bloomington, MN 55435-5435
Phone (952) 835-9880
6110 Golden Hills Dr
Golden Valley, MN 55416-1020
Phone (952) 835-9880
7115 Tamarack Rd
Suite 150
Woodbury, MN 55125-1208
Phone (651) 789-7000
Hospital & facility affiliations
- Maple Grove Hospital
- North Memorial Health Hospital
- Abbott Northwestern Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 94.23
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10548 | MN | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency Physicians Professional Association | Current | Accepting new patients | |
| Emergency Physicians Professional Association | Current | Accepting new patients | |
| Charles Emergency Physicians PA | Past | Accepting new patients |
Locations
9875 Hospital Dr
Maple Grove, MN 55369
Phone (763) 581-1000
4300 Marketpointe Dr
Ste 100
Minneapolis, MN 55435
Phone (952) 767-4574
3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048
1159 County Rd E W
Saint Paul, MN 55112
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.
-
- Emergency Medicine Physician
- Bloomington, MN
- NPI 1801871934
-
- Urgent Care Clinic/Center
- Golden Valley, MN
- NPI 1750188488
-
- Emergency Medicine Physician
- Baltimore, MD
- NPI 1588610166
Hospital & facility affiliations 28
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Obesity Medicine (Family Medicine) Physician
- Minneapolis, MN
- NPI 1154684835
Hospital
-
- Physical Medicine & Rehabilitation Physician
- Minneapolis, MN
- NPI 1275577215
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528761600000",
"number": "1598866352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4300 MARKETPOINTE DR STE 100",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554355435",
"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": "4300 MARKETPOINTE DR STE 100",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554355435",
"telephone_number": "952-835-9880",
"fax_number": "952-857-1554"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARCUCCIO",
"first_name": "DOMINIC",
"middle_name": "J",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-26",
"last_updated": "2018-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "10548",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41953200",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2018; 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.