NPIMap

Individual provider Active NPI

Roberta Van Amber Prigge

  • Sports Medicine (Family Medicine) Physician
  • Maple Grove, MN
National Provider Identifier
1639102825
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
39190 Issued in MN
Practice address
9555 Upland LN N
Maple Grove, MN 55369-4485
Phone
(952) 831-8742
NPI assigned
Jul 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 39190 MN Primary

Addresses

Primary practice location

9555 Upland LN N
Maple Grove, MN 55369-4485

Mailing address

8170 33Rd Ave S # Ms 21110Q
Bloomington, MN 55425-4516

Other practice location 1

300 W Conan St
Ely, MN 55731-1145
Phone (218) 365-7900

Other identifiers 1

IdentifierTypeStateIssuer
795820000MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040708000415 MN Practitioner - Family PracticePractitioner - Emergency Medicine 5890773782 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

19685 Hwy 7
Excelsior, MN 55331-7516
Phone (952) 993-5900

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Tria Orthopaedic Center LLC CurrentSince Dec 1, 2015 Accepting new patients
Park Nicollet Clinic CurrentSince Dec 1, 2015 Accepting new patients
Park Nicollet Clinic Current Accepting new patients
Park Nicollet Clinic CurrentSince Dec 1, 2015 Accepting new patients
The Duluth Clinic, LTD. Past Accepting new patients

Locations

9555 Upland Ln N
Maple Grove, MN 55369
Phone (952) 993-1440

8100 Northland Dr
Minneapolis, MN 55431
Phone (952) 831-1626

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

19685 Highway 7
Shorewood, MN 55331
Phone (952) 993-2900

Interoperability endpoints

  • Direct secure messaging: rprigge155914@direct.healthpartners.com

Organizations & group practices 5

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 6

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": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1639102825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9555 UPLAND LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694485",
            "telephone_number": "952-831-8742"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 W Conan St",
            "address_purpose": "LOCATION",
            "city": "Ely",
            "state": "MN",
            "postal_code": "557311145",
            "country_code": "US",
            "telephone_number": "218-365-7900",
            "fax_number": "218-365-7975",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRIGGE",
        "first_name": "ROBERTA",
        "middle_name": "VAN AMBER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-09",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MN",
            "license": "39190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "795820000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.