Individual provider Active NPI

Nicolai Alan Esala, D.O.

  • Sports Medicine (Family Medicine) Physician
  • Woodbury, MN
National Provider Identifier
1922238245
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
52987 Issued in MN
Practice address
155 Radio Dr
Woodbury, MN 55125-2619
Phone
(952) 831-8742
NPI assigned
Jul 21, 2009
Last updated
Jun 13, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 57008 WI
Sports Medicine (Family Medicine) Physician 207QS0010X 57008 WI
Sports Medicine (Family Medicine) Physician 207QS0010X 52987 MN Primary

Addresses

Primary practice location

155 Radio Dr
Woodbury, MN 55125-2619

Mailing address

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

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
I20101202001196 MN Practitioner - Family PracticePractitioner - Sports Medicine 0840487856 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tria Orthopaedic Center LLCGroup PAC ID 3173570561, 504 clinicians
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

155 Radio Dr
Woodbury, MN 55125-2619
Phone (952) 831-8742

3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone (952) 993-3123

8100 Northland Dr
Bloomington, MN 55431-4800
Phone (952) 831-8742

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Family Medicine CurrentSince Aug 9, 2010 Accepting new patients
Park Nicollet Clinic Family Medicine CurrentSince Aug 9, 2010 Accepting new patients
Tria Orthopaedic Center LLC CurrentSince Oct 12, 2015 Accepting new patients
Park Nicollet Clinic Family Medicine Current Accepting new patients

Locations

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

8100 Northland Dr
Minneapolis, MN 55431
Phone (952) 831-1626

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

3800 Park Nicollet Blvd
St Louis Park, MN 55416
Phone (952) 993-1000

155 Radio Dr
Woodbury, MN 55125
Phone (952) 883-6212

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1922238245",
    "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": "155 RADIO DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252619",
            "telephone_number": "952-831-8742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ESALA",
        "first_name": "NICOLAI",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-21",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "57008",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "WI",
            "license": "57008",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MN",
            "license": "52987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

Verify at the official NPI Registry.