Individual provider Active NPI

Robert C Droullard, MD

  • Family Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1760454219
Registry record updated Mar 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25976 Issued in MN
Practice address
4730 Chicago Ave
Minneapolis, MN 55407-3570
Phone
(952) 967-7676
Fax
(612) 341-1432
NPI assigned
Feb 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25976 MN Primary

Addresses

Primary practice location

4730 Chicago Ave
Minneapolis, MN 55407-3570

Mailing address

8170 33Rd Ave S
Ms 21110Q
Bloomington, MN 55425-4516

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050405000981 MN Practitioner - Family Practice 0547217267 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25976MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Family Medicine CurrentSince Aug 13, 2023 Accepting new patients
Group Health, Inc. CurrentSince Nov 9, 1999 Accepting new patients
Park Nicollet Clinic Family Medicine Current Accepting new patients
Group Health, Inc. Current Accepting new patients
Park Nicollet Clinic Family Medicine CurrentSince Aug 13, 2023 Accepting new patients
Group Health, Inc. CurrentSince Nov 9, 1999 Accepting new patients

Locations

13000 63rd Ave N
Maple Grove, MN 55369
Phone (651) 551-3700

6845 Lee Ave N
Minneapolis, MN 55429
Phone (763) 503-4400

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

8170 33rd Ave S
Minneapolis, MN 55425
Phone (952) 883-5463

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

4730 Chicago Ave
Minneapolis, MN 55407
Phone (612) 313-0000

Organizations & group practices 6

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": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1760454219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "address_2": "MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073570",
            "telephone_number": "952-967-7676",
            "fax_number": "612-341-1432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DROULLARD",
        "first_name": "ROBERT",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "25976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.