Active NPI
Nicole Elyse Wunderlich, MD
- Emergency Medicine Physician
- Bloomington, MN
National Provider Identifier
1881334233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 4351049263APP22
- Practice address
- 4300 Market Pte Dr Ste 100
Bloomington, MN 55435-5435 - Phone
- (952) 767-4574
- NPI assigned
- Mar 31, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medical Services (Emergency Medicine) Physician | 207PE0004X | 4351049263APP22 | MI | |
| Emergency Medicine Physician | 207P00000X | 4351049263APP22 | MI | Primary |
Addresses
Primary practice location
4300 Market Pte Dr Ste 100
Bloomington, MN 55435-5435
Mailing address
1041 Gretchen LN
Grand Ledge, MI 48837-1874
Phone (763) 331-5258
Other practice location 1
2900 Collins Rd
Lansing, MI 48910-8394
Phone (517) 975-6000
Other practice location 2
1215 E Michigan Ave
Lansing, MI 48912-1896
Phone (517) 364-1000
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
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4300 Marketpointe Dr
Suite 100
Bloomington, MN 55435-5435
Phone (952) 835-9880
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4351049263APP22 | MI | MD | Emergency Medical Services (Emergency Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency Physicians Professional Association | Emergency Medicine | Current | Accepting new patients |
| Emergency Physicians Professional Association | Current | Accepting new patients | |
| Emergency Physicians Professional Association | Current | Accepting new patients |
Locations
4300 Marketpointe Dr
Ste 100
Minneapolis, MN 55435
Phone (952) 767-4574
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.
-
- Emergency Medicine Physician
- Bloomington, MN
- NPI 1801871934
-
- Urgent Care Clinic/Center
- Vadnais Heights, MN
- NPI 1134468465
-
- Urgent Care Clinic/Center
- Golden Valley, MN
- NPI 1750188488
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Maple Grove, MN
- NPI 1225272552
-
- General Acute Care Hospital
- Robbinsdale, MN
- NPI 1851344907
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731283200000",
"number": "1881334233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1041 GRETCHEN LN",
"city": "GRAND LEDGE",
"state": "MI",
"postal_code": "488371874",
"telephone_number": "763-331-5258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4300 MARKET PTE DR STE 100",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554355435",
"telephone_number": "952-767-4574"
}
],
"practiceLocations": [
{
"address_1": "2900 Collins Rd",
"address_purpose": "LOCATION",
"city": "Lansing",
"state": "MI",
"postal_code": "489108394",
"country_code": "US",
"telephone_number": "517-975-6000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1215 E Michigan Ave",
"address_purpose": "LOCATION",
"city": "Lansing",
"state": "MI",
"postal_code": "489121896",
"country_code": "US",
"telephone_number": "517-364-1000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WUNDERLICH",
"first_name": "NICOLE",
"middle_name": "ELYSE",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-03-31",
"last_updated": "2024-11-11",
"certification_date": "2024-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "207PE0004X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Emergency Medical Services",
"state": "MI",
"license": "4351049263APP22",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MI",
"license": "4351049263APP22",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.