Individual provider Active NPI

Will Nicholson, M.D.

  • Family Medicine Physician
  • Saint Paul, MN
National Provider Identifier
1881808780
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
NONE Issued in MN
Practice address
1414 Maryland Ave E
Saint Paul, MN 55106-2824
Phone
(651) 722-3461
Fax
(651) 772-2605
NPI assigned
May 9, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NONE MN Primary

Addresses

Primary practice location

1414 Maryland Ave E
Saint Paul, MN 55106-2824

Mailing address

2590 Bittersweet LN
Maplewood, MN 55109-2104
Phone (651) 470-5522

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
I20080109000107 MN Practitioner - Family Practice 0042390643 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1575 Beam Ave
Maplewood, MN 55109-1126
Phone (651) 232-7000

1700 University Ave W
Saint Paul, MN 55104-3727

1925 Woodwinds Dr
Woodbury, MN 55125-4445
Phone (651) 232-0100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.68 of 100Reported as group
Quality
89.73
Promoting interoperability
100
Improvement activities
40
Cost
80.99

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NONEMNMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Healtheast Medical Research Institute CurrentSince Jun 1, 2009 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Healtheast St. John'S Hospital Past Accepting new patients

Locations

6936 Pine Arbor Dr S
Ste 100
Cottage Grove, MN 55016
Phone (651) 326-5800

1215 Town Centre Dr
Eagan, MN 55123
Phone (651) 326-1515

14688 Everton Ave N
Ste 101
Hugo, MN 55038
Phone (651) 275-4706

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

69 Exchange St W
Saint Paul, MN 55102
Phone (651) 232-1100

980 Rice St
Saint Paul, MN 55117
Phone (651) 326-9020

2945 Hazelwood St
Ste 100
Saint Paul, MN 55109
Phone (651) 232-7800

870 Grand Ave
Saint Paul, MN 55105
Phone (651) 326-5650

1983 Sloan Pl
Ste 1
Saint Paul, MN 55117
Phone (651) 326-5700

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

1099 Helmo Ave N
Ste 100
Saint Paul, MN 55128
Phone (651) 326-5300

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

1700 University Ave W
Fl 1
Saint Paul, MN 55104
Phone (651) 232-2002

480 Highway 96 E
Vadnais Heights, MN 55127
Phone (651) 326-5900

1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100

1875 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-6700

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.

Hospital & facility affiliations 2

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": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881808780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2590 BITTERSWEET LN",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551092104",
            "telephone_number": "651-470-5522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 MARYLAND AVE E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551062824",
            "telephone_number": "651-722-3461",
            "fax_number": "651-772-2605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "WILL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "NONE",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.