Individual provider Active NPI

Clarice R Decker, MD

  • Obstetrics & Gynecology Physician
  • Coon Rapids, MN
National Provider Identifier
1669441960
Registry record updated Nov 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
37105 Issued in MN
Practice address
11475 Robinson Dr NW
Coon Rapids, MN 55433-3746
Phone
(763) 587-9000
Fax
(763) 587-9130
NPI assigned
Mar 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 37105 MN Primary

Addresses

Primary practice location

11475 Robinson Dr NW
Coon Rapids, MN 55433-3746

Mailing address

11475 Robinson Dr NW
Coon Rapids, MN 55433-3746
Phone (763) 587-9000

Other identifiers 1

IdentifierTypeStateIssuer
719025500MedicaidMN

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
I20041105000812 MN Practitioner - Obstetrics/Gynecology 3476516915 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Vanderbilt University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

11475 Robinson Dr NW
Coon Rapids, MN 55433-3746
Phone (763) 754-0041

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health Plan, Inc. CurrentSince Nov 1, 2004 Accepting new patients
Group Health, Inc. CurrentSince Nov 1, 2004 Accepting new patients
Group Health, Inc. Current Accepting new patients

Locations

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

11475 Robinson Dr NW
Minneapolis, MN 55433
Phone (763) 587-9000

11475 Robinson Dr NW
#32600A
Minneapolis, MN 55433
Phone (763) 587-9000

Interoperability endpoints

  • Direct secure messaging: cdecker23603@direct.healthpartners.com

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": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384128000000",
    "number": "1669441960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11475 ROBINSON DR NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333746",
            "telephone_number": "763-587-9000",
            "fax_number": "763-587-9130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11475 ROBINSON DR NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333746",
            "telephone_number": "763-587-9000",
            "fax_number": "763-587-9130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECKER",
        "first_name": "CLARICE",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-17",
        "last_updated": "2013-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "37105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "719025500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coon Rapids, MN

Sources for this page

Verify at the official NPI Registry.