Individual provider Active NPI

Luke David Tourville, PA-C

  • Physician Assistant
  • Minnetonka, MN
National Provider Identifier
1750859799
Registry record updated Oct 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12838 Issued in MN
Practice address
4848 County Road 101
Minnetonka, MN 55345-2635
Phone
(763) 226-0084
NPI assigned
Nov 7, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 12838 MN Primary

Addresses

Primary practice location

4848 County Road 101
Minnetonka, MN 55345-2635

Mailing address

4848 County Road 101
Minnetonka, MN 55345-2635
Phone (763) 226-0084

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190111000152 MN Practitioner - Physician Assistant 5890031835 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minuteclinic Primary Care Minnesota PLLCGroup PAC ID 2163945460, 30 clinicians
Minuteclinic Diagnostic of Minnesota PAGroup PAC ID 7810289949, 83 clinicians

Practice addresses (Care Compare)

1010 W Lake St
Minneapolis, MN 55408-2883
Phone (866) 389-2727

1040 Grand Ave
Saint Paul, MN 55105-3001
Phone (866) 389-2727

1500 109TH Ave NE
Blaine, MN 55449-4670
Phone (866) 389-2727

4848 County Rd
Suite 101
Minnetonka, MN 55345-2635
Phone (866) 389-2727

875 E Main St
Waconia, MN 55387-1081
Phone (866) 389-2727

8900 Hwy 7
Minneapolis, MN 55426-3919
Phone (866) 389-2727

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1541548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666742400000",
    "number": "1750859799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4848 COUNTY ROAD 101",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553452635",
            "telephone_number": "763-226-0084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4848 COUNTY ROAD 101",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553452635",
            "telephone_number": "763-226-0084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOURVILLE",
        "first_name": "LUKE",
        "middle_name": "DAVID",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-07",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minnetonka, MN

Sources for this page

Verify at the official NPI Registry.