Individual provider Active NPI

Madison Rose Culliver, PA

  • Medical Physician Assistant
  • Robbinsdale, MN
National Provider Identifier
1871295006
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
15060 Issued in MN
Practice address
3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone
(763) 520-5200
NPI assigned
Mar 21, 2023
Last updated
Dec 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 15060 MN Primary

Addresses

Primary practice location

3300 Oakdale Ave N
Robbinsdale, MN 55422-2926

Mailing address

6557 Mackenzie Ave NE
Otsego, MN 55301-4615

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, MN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20241003002404 MO Practitioner - Physician Assistant 1951832724 Reassigns benefits to 1 organization
I20241218001629 MN Practitioner - Physician Assistant 1951832724 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Memorial Health CareGroup PAC ID 0042123028, 502 clinicians

Practice addresses (Care Compare)

3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone (763) 581-5400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
15060MNMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care Group CurrentSince Oct 1, 2024 Accepting new patients
North Memorial Health Care CurrentSince Jan 1, 2025 Accepting new patients
North Memorial Health Care CurrentSince Jan 1, 2025 Accepting new patients
SSM Health Care Group CurrentSince Oct 1, 2024 Accepting new patients

Locations

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

10101 Woodfield Ln
Saint Louis, MO 63132
Phone (608) 280-4647

6420 Clayton Rd
Saint Louis, MO 63117
Phone (314) 768-8442

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1679356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1871295006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6557 MACKENZIE AVE NE",
            "city": "OTSEGO",
            "state": "MN",
            "postal_code": "553014615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 OAKDALE AVE N",
            "city": "ROBBINSDALE",
            "state": "MN",
            "postal_code": "554222926",
            "telephone_number": "763-520-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CULLIVER",
        "first_name": "MADISON",
        "middle_name": "ROSE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-21",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "15060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Robbinsdale, MN

Sources for this page

Verify at the official NPI Registry.