Individual provider Active NPI

Wyatt Palmer, DO

  • Internal Medicine Physician
  • Maple Grove, MN
National Provider Identifier
1720426059
Registry record updated Aug 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
78961 Issued in MN
Practice address
9855 Hospital Dr Ste 104
Maple Grove, MN 55369-4648
Phone
(763) 581-5900
Fax
(763) 581-5901
NPI assigned
Jun 9, 2013
Last updated
Aug 7, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 78961 MN Primary
Internal Medicine Physician 207R00000X S2136 TX

Addresses

Primary practice location

9855 Hospital Dr Ste 104
Maple Grove, MN 55369-4648

Mailing address

9855 Hospital Dr Ste 104
Maple Grove, MN 55369-4648
Phone (763) 581-5900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, MN2 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
I20201215001251 TX Practitioner - Internal Medicine 2961789748
I20250926001147 MN Practitioner - Internal Medicine 2961789748 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Memorial Health CareGroup PAC ID 0042123028, 502 clinicians

Practice addresses (Care Compare)

9875 Hospital Dr
Maple Grove, MN 55369-4648
Phone (763) 581-0907

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1252NEMDProfessional Counselor
78961MNMDInternal Medicine Physician
S2136TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Memorial Health Care CurrentSince Sep 1, 2025 Accepting new patients
North Memorial Health Care Current Accepting new patients
North Memorial Health Care CurrentSince Sep 1, 2025 Accepting new patients

Locations

9855 Hospital Dr
Ste 104
Maple Grove, MN 55369
Phone (763) 581-5900

9875 Hospital Dr
Maple Grove, MN 55369
Phone (763) 581-1000

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

Interoperability endpoints

  • Direct secure messaging: wpalmer223174@direct.northmemorial.com

Organizations & group practices 3

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.

Hospital & facility affiliations 5

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": "1370736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754524800000",
    "number": "1720426059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9855 HOSPITAL DR STE 104",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694648",
            "telephone_number": "763-581-5900",
            "fax_number": "763-581-5901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9855 HOSPITAL DR STE 104",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694648",
            "telephone_number": "763-581-5900",
            "fax_number": "763-581-5901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALMER",
        "first_name": "WYATT",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-09",
        "last_updated": "2025-08-07",
        "certification_date": "2025-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "78961",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "S2136",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.