Individual provider Active NPI

Alison Rene Wagenknecht, M.D.

  • Family Medicine Physician
  • Roseville, MN
National Provider Identifier
1922110048
Registry record updated Feb 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
37558 Issued in MN
Practice address
1835 W. Cty Rd C
Roseville, MN 55113
Phone
(763) 785-4500
NPI assigned
Aug 31, 2006
Last updated
Feb 10, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2014

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 37558 MN Primary

Addresses

Primary practice location

1835 W. Cty Rd C
Roseville, MN 55113

Mailing address

1835 W. Cty Rd C
Roseville, MN 55113
Phone (763) 785-4500

Other identifiers 9

IdentifierTypeStateIssuer
1011665OtherMNPREFERRED ONE
88302OtherMNAMERICA'S PPO
0100730OtherMNMEDICA
106664OtherMNUCARE MN
HP19980OtherMNHEALTHPARTNERS
09F08WAOtherMNBCBS OF MN
5882147OtherMNAETNA INS
6603819OtherMNMEDICA URGENT CARE
577314800MedicaidMN

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
I20060103000199 MN Practitioner - Family Practice 6507888799 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1993
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)

2600 39TH Ave NE
Minneapolis, MN 55421-4379
Phone (651) 430-3800

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

4181 108TH Ave NE
Blaine, MN 55449-7439
Phone (651) 430-3800

480 Osborne Rd NE
Suite 100
Fridley, MN 55432-2781
Phone (763) 581-2273

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
North Memorial Health Care CurrentSince Mar 1, 2020 Accepting new patients
North Memorial Health Care Current Accepting new patients
Columbia Park Medical Group, PA Family Medicine Past Accepting new patients

Locations

11855 Ulysses St NE
Ste 110
Blaine, MN 55434
Phone (763) 235-4104

9855 Hospital Dr
Ste 102A
Maple Grove, MN 55369
Phone (763) 581-9220

480 Osborne Rd NE
Ste 100
Minneapolis, MN 55432
Phone (763) 785-4500

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

2600 39th Ave NE
Saint Anthony, MN 55421
Phone (612) 706-2690

Interoperability endpoints

  • Direct secure messaging: awagenknecht127859@direct.northmemorial.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391990400000",
    "number": "1922110048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 W. CTY RD C",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "55113",
            "telephone_number": "763-785-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1835 W. CTY RD C",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "55113",
            "telephone_number": "763-785-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGENKNECHT",
        "first_name": "ALISON",
        "middle_name": "RENE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2014-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "37558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1011665",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICA'S PPO",
            "identifier": "88302",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "0100730",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MN",
            "identifier": "106664",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP19980",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "09F08WA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA INS",
            "identifier": "5882147",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA URGENT CARE",
            "identifier": "6603819",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "577314800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MN

Sources for this page

Verify at the official NPI Registry.