NPIMap

Individual provider Active NPI

Avery Tucker

  • Family Medicine Physician
  • Saint Paul, MN
National Provider Identifier
1811457914
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
67931 Issued in MN
Practice address
2155 Ford Pkwy Ste a
Saint Paul, MN 55116-2799
Phone
(651) 696-5000
NPI assigned
Mar 23, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 67931 MN Primary

Addresses

Primary practice location

2155 Ford Pkwy Ste a
Saint Paul, MN 55116-2799

Mailing address

2020 E 28TH St Ste 104
Minneapolis, MN 55407-1453
Phone (612) 333-0770

Other practice location 1

2020 E 28th St Ste 104
Minneapolis, MN 55407-1453
Phone (612) 333-0770

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
I20220808003285 MN Practitioner - Family Practice 6608109111 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians
Optage IncGroup PAC ID 2264619345, 61 clinicians

Practice addresses (Care Compare)

2270 Ford Pkwy
Suite 200
Saint Paul, MN 55116-3412
Phone (651) 696-5000

2945 Lincoln Dr
Roseville, MN 55113-1338
Phone (651) 631-6570

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Clinics CurrentSince Jul 13, 2022 Accepting new patients
Fairview Health Services CurrentSince Jul 13, 2022 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Clinics CurrentSince Jul 13, 2022 Accepting new patients
Fairview Express Care CurrentSince Jul 13, 2022 Accepting new patients
Fairview Health Services CurrentSince Jul 13, 2022 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Express Care CurrentSince Jul 13, 2022 Accepting new patients
Fairview Clinics Past Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

2020 E 28th St
Ste 104
Minneapolis, MN 55407
Phone (612) 333-0770

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

2270 Ford Pkwy
Ste 200
Saint Paul, MN 55116
Phone (651) 696-5000

2155 Ford Pkwy
Ste A
Saint Paul, MN 55116
Phone (651) 696-5000

Interoperability endpoints

  • Direct secure messaging: atucker477205@fairview.direct-ci.com

Organizations & group practices 12

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": "1553299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1811457914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 E 28TH ST STE 104",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071453",
            "telephone_number": "612-333-0770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2155 FORD PKWY STE A",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551162799",
            "telephone_number": "651-696-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2020 E 28th St Ste 104",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554071453",
            "country_code": "US",
            "telephone_number": "612-333-0770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "AVERY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-23",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "67931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.