Active NPI
Gary R Carlson, MD
- Family Medicine Physician
- Minneapolis, MN
National Provider Identifier
1770545709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 30898
- Practice address
- 2833 Chicago Ave. South
Minneapolis, MN 55407-3799 - Phone
- (612) 863-3333
- NPI assigned
- Apr 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 30898 | MN | Primary |
Addresses
Primary practice location
2833 Chicago Ave. South
Minneapolis, MN 55407-3799
Mailing address
3433 Broadway St NE
Ste 300
Minneapolis, MN 55413-1761
Phone (763) 587-7737
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 416385100 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30898 | MN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581984000000",
"number": "1770545709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3433 BROADWAY ST NE",
"address_2": "STE 300",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554131761",
"telephone_number": "763-587-7737",
"fax_number": "763-587-7069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2833 CHICAGO AVE. SOUTH",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554073799",
"telephone_number": "612-863-3333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "GARY",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-05",
"last_updated": "2020-02-18",
"certification_date": "2020-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "30898",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "416385100",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.