Individual provider Active NPI

Gina Christine Nelson, DC

  • Chiropractor
  • Mahtomedi, MN
National Provider Identifier
1619025855
Registry record updated Mar 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
MN4887 Issued in MN
Practice address
1526 Mahtomedi Avenue
Mahtomedi, MN 55115
Phone
(651) 407-0802
Fax
(651) 407-0812
NPI assigned
Jan 6, 2007
Last updated
Mar 18, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X MN4887 MN Primary
Chiropractor 111N00000X 4887 MN

Addresses

Primary practice location

1526 Mahtomedi Avenue
Mahtomedi, MN 55115

Mailing address

2730 County Road D E
White Bear Lake, MN 55110-5624
Phone (651) 407-0802

Other identifiers 1

IdentifierTypeStateIssuer
996697000MedicaidMN

Other names 1

  • Gina Christine Fiala Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070131000305 MN Practitioner - Chiropractic 7113928391 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2730 County Rd D E
White Bear Lake, MN 55110-5624
Phone (651) 407-0802

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4887MNMDChiropractor
MN4887MNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Mahtomedi Natural Care Center Chiropractor CurrentSince Jan 1, 2007 Accepting new patients

Locations

1526 Mahtomedi Ave
Mahtomedi, MN 55115
Phone (651) 407-0802

2730 County Road D E
White Bear Lk, MN 55110
Phone (651) 407-0802

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1168041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552867200000",
    "number": "1619025855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2730 COUNTY ROAD D E",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551105624",
            "telephone_number": "651-407-0802",
            "fax_number": "651-407-0812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1526 MAHTOMEDI AVENUE",
            "city": "MAHTOMEDI",
            "state": "MN",
            "postal_code": "55115",
            "telephone_number": "651-407-0802",
            "fax_number": "651-407-0812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "GINA",
        "middle_name": "CHRISTINE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-06",
        "last_updated": "2019-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "MN4887",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4887",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "996697000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GINA",
            "last_name": "FIALA",
            "middle_name": "CHRISTINE",
            "credential": "DC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mahtomedi, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.