NPIMap

Individual provider Active NPI

Annie M Jacobsen, M.D.

  • Hematology & Oncology Physician
  • Stillwater, MN
National Provider Identifier
1780002592
Registry record updated Sep 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
61631 Issued in MN
Practice address
921 Greeley St S
Stillwater, MN 55082-5935
Phone
(651) 439-1234
NPI assigned
Mar 31, 2014
Last updated
Sep 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 61631 MN
Hematology & Oncology Physician 207RH0003X 61631 MN Primary

Addresses

Primary practice location

921 Greeley St S
Stillwater, MN 55082-5935

Mailing address

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

Other practice location 1

640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 254-3448

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
I20170607001589 MN Practitioner - Internal Medicine 3577831973 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Minnesota Medical School, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

1500 Curve Crest W Blvd
Stillwater, MN 55082-6040
Phone (651) 439-1234

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
61631MNMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hennepin Healthcare System Inc CurrentSince Jul 10, 2017 Accepting new patients
Group Health, Inc. CurrentSince Aug 23, 2021 Accepting new patients
Hennepin Healthcare System, Inc CurrentSince Jul 10, 2017 Accepting new patients
Group Health, Inc. CurrentSince Aug 23, 2021 Accepting new patients
Group Health, Inc. Current Accepting new patients

Locations

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

701 Park Ave
Minneapolis, MN 55415
Phone (612) 873-6005

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

1500 Curve Crest Blvd W
Stillwater, MN 55082

921 Greeley St S
Stillwater, MN 55082

921 Greeley St S
Lowr
Stillwater, MN 55082
Phone (651) 430-4790

Ownership & related parties

All facility ownership & control disclosures 14

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lakeview HospitalStillwater, MN, CCN 240066 Hospital Corporate Director Sep 28, 2023
Westfields Hospital and ClinicNew Richmond, WI, CCN 521345 Hospital Corporate Director Aug 1, 2023
Westfields Hospital and ClinicNew Richmond, WI, CCN 52Z345 Hospital Corporate Director Aug 1, 2023
Amery Hospital & ClinicAmery, WI, CCN 52Z308 Hospital Corporate Director Aug 1, 2023
Amery Hospital & ClinicAmery, WI, CCN 521308 Hospital Corporate Director Aug 1, 2023
Amery Hospital & Clinic - Behavioral Health CenterAmery, WI, CCN 52M308 Hospital Corporate Director Aug 1, 2023
Hudson Hospital & ClinicsHudson, WI, CCN 52Z335 Hospital Corporate Director Aug 1, 2023
Hudson Hospital & ClinicHudson, WI, CCN 521335 Hospital Corporate Director Aug 1, 2023
Lakeview HomecareOak Park Heights, MN, CCN 248008 Home health agency Corporate Director Aug 1, 2023
Lakeview HospiceOak Park Heights, MN, CCN 241552 Hospice Corporate Director Aug 1, 2023
Amery Hospital & Clinic - Luck ClinicLuck, WI, CCN 528516 Rural health clinic Corporate Director Aug 1, 2023
Clear Lake ClinicClear Lake, WI, CCN 528562 Rural health clinic Corporate Director Aug 1, 2023
Amery Hospital & Clinic - Turtle Lake ClinicTurtle Lake, WI, CCN 528561 Rural health clinic Corporate Director Aug 1, 2023
Amery Hospital & ClinicAmery, WI, CCN 528621 Rural health clinic Corporate Director Aug 1, 2023

Owned or controlled facilities with NPI records 13

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 13

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1396224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1780002592",
    "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": "921 GREELEY ST S",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550825935",
            "telephone_number": "651-439-1234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 Jackson St",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551012502",
            "country_code": "US",
            "telephone_number": "651-254-3448",
            "fax_number": "651-254-3470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACOBSEN",
        "first_name": "ANNIE",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-31",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "61631",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MN",
            "license": "61631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stillwater, MN

Sources for this page

Verify at the official NPI Registry.