Active NPI
Nicole S. Nader, MD
- Pediatrics Physician
- St Louis Park, MN
National Provider Identifier
1821290263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 50084
- Practice address
- 3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527 - Phone
- (952) 883-1000
- NPI assigned
- Jun 5, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 50084 | MN | Primary |
Addresses
Primary practice location
3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Mailing address
8170 33Rd Ave S
PO Box 1309 Mail Stop 21110Q
Minneapolis, MN 55425-4516
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 981615000 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Nicollet Clinic | Pediatrics | Current | Accepting new patients |
| Park Nicollet Clinic | Pediatrics | Current | Accepting new patients |
Locations
5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400
13688 Rogers Dr
Rogers, MN 55374
Phone (952) 977-0300
3800 Park Nicollet Blvd
St Louis Park, MN 55416
Phone (952) 993-1000
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467244800000",
"number": "1821290263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8170 33RD AVE S",
"address_2": "PO BOX 1309 MAIL STOP 21110Q",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554254516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3800 PARK NICOLLET BLVD",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554162527",
"telephone_number": "952-883-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NADER",
"first_name": "NICOLE",
"middle_name": "S.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-05",
"last_updated": "2016-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "50084",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "981615000",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.