Individual provider Active NPI

Alonso Carrasco Jr., MD

  • Pediatric Urology Physician
  • Minneapolis, MN
National Provider Identifier
1710299706
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Urology PhysicianTaxonomy code 2088P0231X
License
54064 Issued in MN
Practice address
2530 Chicago Ave Ste 550
Minneapolis, MN 55404-4293
Phone
(612) 813-8000
Fax
(612) 813-8005
NPI assigned
Jul 8, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Urology Physician 2088P0231X 04-39904 KS
Pediatric Urology Physician 2088P0231X 54064 MN Primary
Pediatric Urology Physician 2088P0231X 2017002201 MO
Pediatric Urology Physician 2088P0231X V8469 TX
Pediatric Urology Physician 2088P0231X DR.0055046 CO

Addresses

Primary practice location

2530 Chicago Ave Ste 550
Minneapolis, MN 55404-4293

Mailing address

4530 77TH St W Ste 205
Edina, MN 55435-5003
Phone (612) 813-8000

Other identifiers 3

IdentifierTypeStateIssuer
ENROLLEDMedicaidWI
P01021777OtherMNRAIL ROAD - MEDICARE
ENROLLEDMedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, ND2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20111105000093 MN Practitioner - UrologyPractitioner - Pediatric Medicine 4981877057 Reassigns benefits to 2 organizations
I20221219000868 ND Practitioner - Urology 4981877057 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Innovis Health LLCGroup PAC ID 9931298155, 561 clinicians

Practice addresses (Care Compare)

3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000

Hospital & facility affiliations

  • Essentia Health Hospital, Fargo, ND, CCN 350070

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0055046COMDPediatric Urology Physician
04-39904KSMDPediatric Urology Physician
V8469TXMDPediatric Urology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gillette Children'S Specialty Healthcare CurrentSince Sep 1, 2022 Accepting new patients
St Alexius Medical Center CurrentSince Aug 26, 2023 Accepting new patients
Gillette Children'S Specialty Healthcare CurrentSince Sep 1, 2022 Accepting new patients
Pediatric Surgical Associates LTD Pediatric Urology CurrentSince Sep 1, 2022 Accepting new patients
St. Alexius Medical Center CurrentSince Aug 26, 2023 Accepting new patients
Innovis Health, LLC Current Accepting new patients
Innovis Health LLC CurrentSince Dec 9, 2022 Accepting new patients
Innovis Health LLC CurrentSince Dec 9, 2022 Accepting new patients
Kansas City Vascular & General Surgery Group LLC Past Accepting new patients
Childrens Health Care Past Accepting new patients
Gillette Children'S Specialty Healthcare PastSince Sep 1, 2022 Accepting new patients

Locations

2530 Chicago Ave
Minneapolis, MN 55404
Phone (612) 813-6000

4530 77th St W
Ste 205
Minneapolis, MN 55435
Phone (952) 835-3375

2530 Chicago Ave
Ste 550
Minneapolis, MN 55404
Phone (612) 810-8000

5354 Edgewood Dr
Saint Paul, MN 55112

200 University Ave E
Saint Paul, MN 55101
Phone (651) 291-2848

900 E Broadway Ave
Bismarck, ND 58501
Phone (701) 530-7300

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000

1702 University Dr S
Fargo, ND 58103
Phone (701) 364-4222

Organizations & group practices 11

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761091200000",
    "number": "1710299706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4530 77TH ST W STE 205",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554355003",
            "telephone_number": "612-813-8000",
            "fax_number": "952-835-9443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 CHICAGO AVE STE 550",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044293",
            "telephone_number": "612-813-8000",
            "fax_number": "612-813-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRASCO",
        "first_name": "ALONSO",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-08",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "KS",
            "license": "04-39904",
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "MN",
            "license": "54064",
            "primary": true
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "MO",
            "license": "2017002201",
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "TX",
            "license": "V8469",
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "CO",
            "license": "DR.0055046",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD - MEDICARE",
            "identifier": "P01021777",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.