NPIMap

Organization Active NPI

Spark Medical Providers PA

  • Geriatric Medicine (Internal Medicine) Physician
  • St Louis Park, MN
National Provider Identifier
1760374680
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
SPARK MEDICAL PROVIDERS PA
Practice address
5320 W 23Rd St Ste 130
St Louis Park, MN 55416-1670
Phone
(952) 345-8770
NPI assigned
Jul 16, 2025
Last updated
Jul 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

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

Authorized official

Name
Catherine Ann Lauring, NURSE PRACTITIONERNPI 1982692232
Title
Ceo
Phone
(952) 345-8770

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X Primary

Addresses

Primary practice location

5320 W 23Rd St Ste 130
St Louis Park, MN 55416-1670

Mailing address

5320 W 23Rd St Ste 130
St Louis Park, MN 55416-1670
Phone (952) 345-8770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251208002385 MN Part B Supplier - Clinic/Group Practice 5193219186 Receives reassigned benefits from 21 practitioners
Practice locations: St Louis Park, MN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1752624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752624000000",
    "number": "1760374680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5320 W 23RD ST STE 130",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161670",
            "telephone_number": "952-345-8770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5320 W 23RD ST STE 130",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161670",
            "telephone_number": "952-345-8770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARK MEDICAL PROVIDERS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-16",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A",
        "authorized_official_last_name": "LAURING",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "952-345-8770",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.