Individual provider Active NPI

Gregg Michael Poquette, D.C.

  • Chiropractor
  • Eagan, MN
National Provider Identifier
1679657001
Registry record updated Sep 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2402 Issued in MN
Practice address
4660 Slater Rd
Suite 140
Eagan, MN 55122-4047
Phone
(651) 452-3900
Fax
(651) 452-3901
NPI assigned
Oct 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2402 MN Primary

Addresses

Primary practice location

4660 Slater Rd
Suite 140
Eagan, MN 55122-4047

Mailing address

4660 Slater Rd
Suite 140
Eagan, MN 55122-4047
Phone (651) 452-3900

Other identifiers 2

IdentifierTypeStateIssuer
344328100MedicaidMN
51364POOtherMNBLUE CROSS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110125000958 MN Practitioner - Chiropractic 9638358476 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4660 Slater Rd
Suite 140
Eagan, MN 55122-4049
Phone (651) 452-3900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Gregg M Poquette B.S. D.C. P.a. Chiropractor CurrentSince Jan 24, 1987 Accepting new patients

Locations

4660 Slater Rd
Ste 140
Saint Paul, MN 55122
Phone (651) 452-3900

Organizations & group practices 2

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": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315785600000",
    "number": "1679657001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4660 SLATER RD",
            "address_2": "SUITE 140",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551224047",
            "telephone_number": "651-452-3900",
            "fax_number": "651-452-3901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4660 SLATER RD",
            "address_2": "SUITE 140",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551224047",
            "telephone_number": "651-452-3900",
            "fax_number": "651-452-3901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POQUETTE",
        "first_name": "GREGG",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2011-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "2402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344328100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "51364PO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; 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.