Nicole Anne Bemmels Carlson, M.S.P.A.
Individual provider Active NPI Physician Assistant · St. Luois Park, MN
NPI 1700820883 · NPPES record last updated Jan 26, 2017
Key facts
- NPI
- 1700820883
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 9899 (MN)
- Practice address
- 6500 Excelsior
Park Nicollet Heart and Vascular Center
St. Luois Park, MN 55426 - Phone
- (612) 423-9088
- NPI assigned
- Jun 16, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Hutchinson Health
Park Nicollet Clinic
Practice addresses (Care Compare)
1029 Hwy 15 S
Hutchinson, MN 55350-3153
Phone (320) 484-4400
1071 Hwy 15 S
Hutchinson, MN 55350-3153
Phone (320) 484-4610
1515 Saint Francis Ave
Shakopee, MN 55379-3387
Phone (952) 993-7750
15800 95TH Ave N
Maple Grove, MN 55369-4400
Phone (952) 993-1440
3 Century Ave SE
Hutchinson, MN 55350-3108
Phone (320) 234-3290
300 Lake Dr E
Chanhassen, MN 55317-9302
Phone (952) 993-4300
3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone (952) 993-3123
3850 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone (952) 993-3123
5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400
6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-3123
8455 Flying Cloud Dr
Eden Prairie, MN 55344-3974
Phone (952) 993-7400
Hospital & facility affiliations
- Park Nicollet Methodist Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041214000083 | MN | Practitioner - Physician Assistant | 1052378841 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Nicollet Methodist Hospital | Current |
Accepting new patients | |
| Park Nicollet Clinic | Current |
Accepting new patients | |
| Hutchinson Medical Center PA | Past | Accepting new patients |
Locations
9555 Upland Ln N
Maple Grove, MN 55369
Phone (952) 993-1440
5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400
6500 Excelsior Blvd
St Louis Park, MN 55426
Phone (952) 993-3246
Interoperability endpoints
- ncarlson157148@direct.healthpartners.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 9899 | MN | Yes |
| Medical Physician Assistant | 363AM0700X | 9899 | MN |
Addresses
Primary practice location
6500 Excelsior
Park Nicollet Heart and Vascular Center
St. Luois Park, MN 55426
Mailing address
6500 Excelsior Blvd.
Park Nicollet Heart and Vascular Center
St. Louis Park, MN 55426
Phone (612) 624-0123
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41995800 | Medicaid | WI | |
| 01-06279 | Other | MN | MEDICA PRIMARY |
| 2230947 | Other | MN | ARAZ |
| 616R8BE | Other | MN | BCBS |
| 01-19215 | Other | MN | MEDICA CHOICE |
| 132339 | Other | MN | UCARE |
| B018 | Other | MN | CHAMPUS/TRIWEST |
| 916427800 | Medicaid | MN | |
| 1042013 | Other | MN | PREFERRED ONE |
| HP46702 | Other | MN | HEALTHPARTNERS |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.