NPIMap

Individual provider Active NPI

Susan M Holt, M.D.

  • Dermatology Physician
  • Richfield, MN
National Provider Identifier
1932201639
Registry record updated Mar 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
30007 Issued in MN
Practice address
6425 Nicollet Ave
Suite 202
Richfield, MN 55423-1668
Phone
(612) 869-2086
Fax
(612) 869-4903
NPI assigned
Sep 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 30007 MN Primary

Addresses

Primary practice location

6425 Nicollet Ave
Suite 202
Richfield, MN 55423-1668

Mailing address

8170 33Rd Ave S
Bloomington, MN 55425-4516

Other practice location 1

9555 Upland Ln N
Maple Grove, MN 55369-4485
Phone (952) 993-1440

Other identifiers 6

IdentifierTypeStateIssuer
492003OtherMNPREFERRED ONE
HP13424OtherMNHEALTH PARTNERS
137592000MedicaidMN
100189OtherMNU CARE
49637HOOtherMNBLUE CROSS BLUE SHIELD
0316269OtherMNMEDICA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081021000446 MN Practitioner - Dermatology 8628136579 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Minnesota Medical School, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

15800 95TH Ave N
Maple Grove, MN 55369-4400
Phone (952) 993-1440

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

Hospital & facility affiliations

  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions96
Removal or shaving of skin growth1-10
Skin biopsy35

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
30007MNMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Mar 31, 2014 Accepting new patients
United Skin Specialists, LTD PC Current Accepting new patients
Group Health, Inc. CurrentSince Jan 1, 2014 Accepting new patients
Group Health, Inc. CurrentSince Jan 1, 2014 Accepting new patients
Park Nicollet Clinic CurrentSince Mar 31, 2014 Accepting new patients
Southwest Dermatology Specialists. LTD Dermatology Current Accepting new patients
Group Health, Inc. Current Accepting new patients

Locations

9555 Upland Ln N
Maple Grove, MN 55369
Phone (952) 993-1440

701 Park Ave
Minneapolis, MN 55415
Phone (612) 873-6005

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

8170 33rd Ave S
Minneapolis, MN 55425
Phone (952) 883-5463

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

6425 Nicollet Ave
Ste 20
Richfield, MN 55423

6425 Nicollet Ave
Ste 202
Richfield, MN 55423
Phone (612) 338-0711

Organizations & group practices 7

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 6

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": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615507200000",
    "number": "1932201639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6425 NICOLLET AVE",
            "address_2": "SUITE 202",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554231668",
            "telephone_number": "612-869-2086",
            "fax_number": "612-869-4903"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9555 Upland Ln N",
            "address_purpose": "LOCATION",
            "city": "Maple Grove",
            "state": "MN",
            "postal_code": "553694485",
            "country_code": "US",
            "telephone_number": "952-993-1440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLT",
        "first_name": "SUSAN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-02",
        "last_updated": "2021-03-12",
        "certification_date": "2021-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MN",
            "license": "30007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "492003",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP13424",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137592000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U CARE",
            "identifier": "100189",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "49637HO",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "0316269",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richfield, MN

Sources for this page

Verify at the official NPI Registry.