Individual provider Active NPI

Molly Deignan Martin, CNP

  • Pediatric Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1679314173
Registry record updated Jun 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
11635 Issued in MN
Practice address
701 25TH Ave S
Minneapolis, MN 55454-1513
Phone
(612) 365-6777
NPI assigned
Jun 6, 2024
Last updated
Jun 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 11635 MN Primary

Addresses

Primary practice location

701 25TH Ave S
Minneapolis, MN 55454-1513

Mailing address

11421 Oakvale Rd N
Minnetonka, MN 55305-4353
Phone (612) 910-6980

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240628002963 MN Practitioner - Nurse Practitioner 5890239032 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11635MNMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince Aug 12, 2024 Accepting new patients
University of Minnesota Health Clinics and Surgery Center, Inc. Current Accepting new patients
Fairview Express Care Current Accepting new patients
University of Minnesota Physicians CurrentSince Aug 12, 2024 Accepting new patients
University of Minnesota Physicians Current Accepting new patients
Fairview Express Care CurrentSince Aug 12, 2024 Accepting new patients
Fairview Express Care CurrentSince Aug 12, 2024 Accepting new patients
University of Minnesota Physicians CurrentSince Aug 12, 2024 Accepting new patients
Fairview Health Services Past Accepting new patients

Locations

516 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-3600

701 25th Ave S
Minneapolis, MN 55454
Phone (612) 330-1399

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

720 Washington Ave SE
Ste 300
Minneapolis, MN 55414
Phone (612) 884-0331

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

Interoperability endpoints

  • Direct secure messaging: mmartin482210@fairview.direct-ci.com

Organizations & group practices 9

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": "1717632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1679314173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11421 OAKVALE RD N",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553054353",
            "telephone_number": "612-910-6980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 25TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541513",
            "telephone_number": "612-365-6777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "MOLLY",
        "middle_name": "DEIGNAN",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-06",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "11635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.