Individual provider Active NPI

Mary C Fields, MD

  • Psychiatry Physician
  • St Louis Park, MN
National Provider Identifier
1861497745
Registry record updated Feb 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
47631 Issued in WI
Practice address
3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone
(952) 993-1000
NPI assigned
Jun 16, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 47631 WI Primary

Addresses

Primary practice location

3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527

Mailing address

8170 33Rd Ave S
P.O. Box 1309 Mail Stop 21110Q
Minneapolis, MN 55425-4516
Phone (952) 993-1000

Other identifiers 1

IdentifierTypeStateIssuer
34615900MedicaidWI

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160217000885 MN Practitioner - PsychiatryPractitioner - Other (Physician) 9234189192 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Texas Medical Branch at Galveston, 1997
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)

15800 95TH Ave N
Maple Grove, MN 55369-4400
Phone (952) 993-1440

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20714SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Feb 1, 2016 Accepting new patients
Park Nicollet Clinic CurrentSince Feb 1, 2016 Accepting new patients
South Carolina Dept of Mental Health Accounting Office Past Accepting new patients

Locations

15800 95th Ave N
Maple Grove, MN 55369
Phone (952) 993-1400

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

3800 Park Nicollet Blvd
St Louis Park, MN 55416
Phone (952) 993-1000

Organizations & group practices 3

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": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455235200000",
    "number": "1861497745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "address_2": "P.O. BOX 1309 MAIL STOP 21110Q",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554254516",
            "telephone_number": "952-993-1000"
        },
        {
            "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": "952-993-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIELDS",
        "first_name": "MARY",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-16",
        "last_updated": "2016-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WI",
            "license": "47631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34615900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.