NPIMap

Individual provider Active NPI

Madeline Wallenburg, PA-C

  • Physician Assistant
  • Saint Louis Park, MN
National Provider Identifier
1891462032
Registry record updated Jun 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
15758 Issued in MN
Practice address
3931 Louisiana Ave S
Saint Louis Park, MN 55426-4375
Phone
(952) 993-3200
NPI assigned
Aug 25, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-15466 NC
Physician Assistant 363A00000X 15758 MN Primary

Addresses

Primary practice location

3931 Louisiana Ave S
Saint Louis Park, MN 55426-4375

Mailing address

8170 33Rd Ave S # Ms 21110Q
Bloomington, MN 55425-4516

Other practice location 1

225 Baldwin Ave
Charlotte, NC 28204-3109
Phone (704) 376-1605

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, NC, MN3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20230530001064 WI Practitioner - Physician Assistant 1052778537 Reassigns benefits to 1 organization
I20251220000657 NC Practitioner - Physician Assistant 1052778537 Reassigns benefits to 2 organizations
I20260618001431 MN Practitioner - Physician Assistant 1052778537 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

225 Baldwin Ave
Charlotte, NC 28204-3109
Phone (704) 376-1605

3931 Louisiana Ave S
St Louis Park, MN 55426-5000
Phone (952) 993-3123

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-15466NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Atrium Health Neurospine Network LLC CurrentSince Nov 10, 2025 Accepting new patients
Atrium Health Neurospine Network LLC CurrentSince Nov 10, 2025 Accepting new patients

Locations

225 Baldwin Ave
Charlotte, NC 28204
Phone (704) 376-1605

110 Lake Concord Rd NE
Concord, NC 28025
Phone (704) 792-2672

Interoperability endpoints

  • Direct secure messaging: mwallenburg3046143@carolinashealthcaresystem.direct-ci.com
  • FHIR API: https://epicproxy.et0905.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 4

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 8

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": "1629849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781136000000",
    "number": "1891462032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3931 LOUISIANA AVE S",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554264375",
            "telephone_number": "952-993-3200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "225 Baldwin Ave",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282043109",
            "country_code": "US",
            "telephone_number": "704-376-1605",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLENBURG",
        "first_name": "MADELINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-25",
        "last_updated": "2026-06-11",
        "certification_date": "2026-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-15466",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "15758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis Park, MN

Sources for this page

Verify at the official NPI Registry.