NPIMap

Individual provider Active NPI

Stacey Mackay

  • Family Medicine Physician
  • St Louis Park, MN
National Provider Identifier
1760469175
Registry record updated Aug 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
41342 Issued in MN
Practice address
3850 Park Nicollet Blvd
Park Nicollet Clinic - SLP
St Louis Park, MN 55416
Phone
(952) 993-3025
Fax
(952) 993-1937
NPI assigned
Dec 28, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2018

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 41342 MN Primary

Addresses

Primary practice location

3850 Park Nicollet Blvd
Park Nicollet Clinic - SLP
St Louis Park, MN 55416

Mailing address

6465 Wayzata Blvd
Ste 315
St Louis Park, MN 55426-1728
Phone (952) 993-7169

Other practice location 1

2220 Riverside Ave
Minneapolis, MN 55454-1321
Phone (612) 371-1600

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
I20060727000223 MN Practitioner - Family Practice 4587677182 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Virginia School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

14000 Fairview Dr
Burnsville, MN 55337-5713
Phone (952) 993-8700

300 Lake Dr E
Chanhassen, MN 55317-9302
Phone (952) 993-4300

3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone (952) 993-3123

3850 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone (952) 993-3123

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41342MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Family Medicine CurrentSince Jul 5, 2006 Accepting new patients
Group Health, Inc. CurrentSince Jun 15, 2018 Accepting new patients
Park Nicollet Clinic Family Medicine Current Accepting new patients
Group Health, Inc. CurrentSince Jun 15, 2018 Accepting new patients
Park Nicollet Methodist Hospital CurrentSince Jul 5, 2006 Accepting new patients

Locations

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

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

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

3850 Park Nicollet Blvd
St Louis Park, MN 55416
Phone (952) 883-1000

Organizations & group practices 5

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.

Hospital & facility affiliations 6

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": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534204800000",
    "number": "1760469175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6465 WAYZATA BLVD",
            "address_2": "STE 315",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261728",
            "telephone_number": "952-993-7169",
            "fax_number": "952-993-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 PARK NICOLLET BLVD",
            "address_2": "PARK NICOLLET CLINIC - SLP",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "55416",
            "telephone_number": "952-993-3025",
            "fax_number": "952-993-1937"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2220 Riverside Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554541321",
            "country_code": "US",
            "telephone_number": "612-371-1600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACKAY",
        "first_name": "STACEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-28",
        "last_updated": "2018-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "41342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.