Rachel L Agneberg, DO
Individual provider Active NPI Family Medicine Physician · St Louis Park, MN
NPI 1831453786 · NPPES record last updated Mar 9, 2021
Key facts
- NPI
- 1831453786
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 59640 (MN)
- Practice address
- 3850 Park Nicollet Blvd
St Louis Park, MN 55416-2527 - Phone
- (952) 993-1000
- NPI assigned
- Jun 26, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 14
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Park Nicollet Clinic
Practice addresses (Care Compare)
3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone (952) 993-3123
Hospital & facility affiliations
- Park Nicollet Methodist Hospital
- Regions Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150923002166 | MN | Practitioner - Family Practice | 1557502051 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R9560 | IA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Nicollet Clinic | Family Medicine | Current | Accepting new patients |
| Park Nicollet Clinic | Family Medicine | Current |
Accepting new patients |
| Park Nicollet Clinic | Family Medicine | Current |
Accepting new patients |
| Park Nicollet Methodist Hospital | Past | Accepting new patients |
Locations
5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400
3800 Park Nicollet Blvd
St Louis Park, MN 55416
Phone (952) 993-1000
3850 Park Nicollet Blvd
St Louis Park, MN 55416
Phone (952) 883-1000
Interoperability endpoints
- ragneberg155097@direct.healthpartners.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R9560 | IA | |
| Family Medicine Physician | 207Q00000X | 59640 | MN | Yes |
Addresses
Primary practice location
3850 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
Phone (952) 883-6212
Other providers in St Louis Park, MN
- Aeris Medical Group PLLC
- Andrew Michael Aeshliman
- Muhammad Affan
- Afiya Spiritual Life Center, LLC
- Damilola Jakub Agboluaje
- Kwao Gareth Ahelegbe
- Hadith Yusuf Ahmed
- Sagal Abdiaziz Ahmed
- Seefen Ahmed
- Michael B Ainslie
All providers in St Louis Park, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.