Active NPI
Mark David Connelly, M.D.
- Emergency Medicine Physician
- Saint Paul, MN
National Provider Identifier
1679743538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 18853
- Practice address
- 333 Smith Ave N
Saint Paul, MN 55102-2344 - Phone
- (651) 241-5398
- NPI assigned
- Mar 7, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 18853 | MN | Primary |
Addresses
Primary practice location
333 Smith Ave N
Saint Paul, MN 55102-2344
Mailing address
2829 University Ave SE Ste 730
Minneapolis, MN 55414-3279
Phone (651) 241-5398
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- University of Minnesota Medical School, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1175 Nininger Rd
Hastings, MN 55033-1056
Phone (651) 404-1000
Hospital & facility affiliations
- Allina United Hospital
- Allina Health Faribault Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 95.56
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18853 | MN | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| International Falls Memorial Hospital Association | Current | Accepting new patients | |
| International Falls Memorial Hospital Association | Current | Accepting new patients | |
| Ecc Addiction & Toxicology Services LLC | Current | Accepting new patients |
Locations
1400 Highway 71
Intl Falls, MN 56649
Phone (218) 283-4481
2829 University Ave SE
Ste 730
Minneapolis, MN 55414
Phone (612) 439-1868
800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547
Organizations & group practices 4
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.
-
- Emergency Medicine Physician
- Minneapolis, MN
- NPI 1669422788
-
- Critical Access Hospital
- International Falls, MN
- NPI 1528041183
-
- Medical Toxicology (Emergency Medicine) Physician
- Minneapolis, MN
- NPI 1629532429
-
- Pharmacy
- International Falls, MN
- NPI 1275284374
Hospital & facility affiliations 17
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Faribault, MN
- NPI 1154741577
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- St Paul, MN
- NPI 1265474704
Hospital
-
- General Acute Care Hospital
- Saint Paul, MN
- NPI 1457319485
-
- General Acute Care Hospital
- Hastings, MN
- NPI 1508457045
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656460800000",
"number": "1679743538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2829 UNIVERSITY AVE SE STE 730",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554143279",
"telephone_number": "651-241-5398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 SMITH AVE N",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551022344",
"telephone_number": "651-241-5398"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNELLY",
"first_name": "MARK",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-03-07",
"last_updated": "2022-06-29",
"certification_date": "2022-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MN",
"license": "18853",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.