NPIMap

Individual provider Active NPI

Madeline Rose Jagerson, MD

  • Family Medicine Physician
  • St Louis Park, MN
National Provider Identifier
1811578149
Registry record updated Jul 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
72858 Issued in MN
Practice address
6600 Excelsior Blvd Ste 160
St Louis Park, MN 55426-4713
Phone
(952) 993-7705
NPI assigned
Apr 19, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 72858 MN Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

6600 Excelsior Blvd Ste 160
St Louis Park, MN 55426-4713

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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240904002967 MN Practitioner - Family Practice 7810391950 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

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

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

8455 Flying Cloud Dr
Eden Prairie, MN 55344-3974
Phone (952) 993-7400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Family Medicine CurrentSince Aug 5, 2024 Accepting new patients
Park Nicollet Clinic Family Medicine Current Accepting new patients

Locations

8455 Flying Cloud Dr
Eden Prairie, MN 55344
Phone (952) 883-9040

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

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

6600 Excelsior Blvd
Ste 160
St Louis Park, MN 55426
Phone (952) 993-7700

Organizations & group practices 2

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 8

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": "1618790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1811578149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 EXCELSIOR BLVD STE 160",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264713",
            "telephone_number": "952-993-7705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAGERSON",
        "first_name": "MADELINE",
        "middle_name": "ROSE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-19",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "72858",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.