NPIMap

Individual provider Active NPI

Scott D Wissink, MD

  • Sports Medicine (Family Medicine) Physician
  • Bloomington, MN
National Provider Identifier
1942425061
Registry record updated Sep 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
53239 Issued in MN
Practice address
8100 Northland Dr
Bloomington, MN 55431-4800
Phone
(952) 831-8742
Fax
(952) 831-1626
NPI assigned
Apr 16, 2007
Last updated
Sep 15, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 53239 MN Primary
Orthopaedic Surgery Physician 207X00000X MD427066 PA

Addresses

Primary practice location

8100 Northland Dr
Bloomington, MN 55431-4800

Mailing address

8170 33Rd Ave S
Mailstop 21110Q
Bloomington, MN 55425-4516
Phone (952) 883-6000

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
I20110311000249 MN Practitioner - Sports MedicinePractitioner - Family Practice 1850482993 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Sports MedicineAlso: Family Practice
Education
University of Minnesota Medical School, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tria Orthopaedic Center LLCGroup PAC ID 3173570561, 504 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD427066PAMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Nov 5, 2015 Accepting new patients
Tria Orthopaedic Center LLC Orthopaedic Surgery CurrentSince Jan 1, 2011 Accepting new patients
Park Nicollet Clinic CurrentSince Nov 5, 2015 Accepting new patients
Windber Hospital, Inc. Past Accepting new patients
Upmc St. Margaret Past Accepting new patients

Locations

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

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

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

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.

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": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789430400000",
    "number": "1942425061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "address_2": "MAILSTOP 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516",
            "telephone_number": "952-883-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8100 NORTHLAND DR",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554314800",
            "telephone_number": "952-831-8742",
            "fax_number": "952-831-1626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISSINK",
        "first_name": "SCOTT",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-16",
        "last_updated": "2026-09-15",
        "certification_date": "2026-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MN",
            "license": "53239",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "PA",
            "license": "MD427066",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, MN

Sources for this page

Verify at the official NPI Registry.