NPIMap

Individual provider Active NPI

Mark B Juckett, MD

  • Hematology (Internal Medicine) Physician
  • Minneapolis, MN
National Provider Identifier
1750357604
Registry record updated Feb 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology (Internal Medicine) PhysicianTaxonomy code 207RH0000X
License
35344 Issued in WI
Practice address
2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone
(612) 672-6000
Fax
(612) 273-4098
NPI assigned
Feb 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35344 WI
Hematology & Oncology Physician 207RH0003X 35344 WI
Medical Oncology Physician 207RX0202X 35344 WI
Hematology (Internal Medicine) Physician 207RH0000X 35344 WI Primary

Addresses

Primary practice location

2450 Riverside Ave
Minneapolis, MN 55454-1450

Mailing address

2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone (612) 672-6000

Other practice location 1

600 Highland Ave
Madison, WI 53792
Phone (608) 265-1700

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mjuckett5580@direct.uwhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210118000488 MN Practitioner - Hematology/Oncology 2860557170 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

500 Harvard St SE
Minneapolis, MN 55455-0363
Phone (612) 672-7422

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.63 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35344WIMDMedical Oncology Physician
32403MNMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Express Care CurrentSince Dec 31, 2020 Accepting new patients
University of Minnesota Physicians CurrentSince Feb 26, 2021 Accepting new patients
University of Minnesota Physicians Current Accepting new patients
Fairview Clinics Current Accepting new patients
University of Minnesota Physicians CurrentSince Feb 26, 2021 Accepting new patients
Fairview Health Services CurrentSince Dec 31, 2020 Accepting new patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince Feb 26, 2021 Accepting new patients
Fairview Clinics CurrentSince Dec 31, 2020 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Health Services Current Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Clinics CurrentSince Dec 31, 2020 Accepting new patients
University of Minnesota Health Clinics and Surgery Center, Inc. CurrentSince Feb 26, 2021 Accepting new patients
Healtheast Medical Research Institute Internal Medicine CurrentSince Feb 19, 2022 Accepting new patients
Fairview Health Services CurrentSince Dec 31, 2020 Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

14500 99th Ave N
Ste 100
Maple Grove, MN 55369
Phone (763) 898-1000

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

516 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-3600

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

6341 University Ave NE
Minneapolis, MN 55432
Phone (763) 427-9980

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

6401 France Ave S
Minneapolis, MN 55435
Phone (952) 920-8477

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

400 Stinson Blvd
Fl 2
Minneapolis, MN 55413
Phone (612) 672-2203

919 Northland Dr
Princeton, MN 55371
Phone (763) 389-3344

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

Interoperability endpoints

  • Direct secure messaging: mjuckett605262@fairview.direct-ci.com
  • Direct secure messaging: mjuckett5580@direct.uwhealth.org

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 8

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": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613433600000",
    "number": "1750357604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-672-6000",
            "fax_number": "612-273-4098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-672-6000",
            "fax_number": "612-273-4098"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Highland Ave",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "53792",
            "country_code": "US",
            "telephone_number": "608-265-1700",
            "fax_number": "608-266-6020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JUCKETT",
        "first_name": "MARK",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "35344",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "WI",
            "license": "35344",
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "WI",
            "license": "35344",
            "primary": false
        },
        {
            "code": "207RH0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology",
            "state": "WI",
            "license": "35344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mjuckett5580@direct.uwhealth.org",
            "affiliation": "N",
            "address_1": "600 Highland Ave",
            "city": "Madison",
            "state": "WI",
            "country_code": "US",
            "postal_code": "53792",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.