NPIMap

Individual provider Active NPI

Jennifer Bottem, FNP

  • Family Nurse Practitioner
  • Saint Paul, MN
National Provider Identifier
1972579464
Registry record updated May 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R125822-0 Issued in MN
Practice address
2155 Ford Pkwy
Saint Paul, MN 55116-1862
Phone
(651) 696-5000
NPI assigned
Feb 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R125822-0 MN Primary

Addresses

Primary practice location

2155 Ford Pkwy
Saint Paul, MN 55116-1862

Mailing address

2155 Ford Pkwy
Saint Paul, MN 55116-1862

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
I20050128000177 MN Practitioner - Nurse Practitioner 0648220558 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

1440 Duckwood Dr
Eagan, MN 55122-1451
Phone (651) 406-8860

1700 University Ave W
Saint Paul, MN 55104-3727
Phone (952) 914-1732

2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone (612) 672-6000

5200 Fairview Blvd
Wyoming, MN 55092-8013
Phone (651) 982-7000

Hospital & facility affiliations

  • Accentcare Fairview Home Health - West, LLC Home health agency, Saint Paul, MN, CCN 247078
  • Allina Health Home Health Home health agency, Minneapolis, MN, CCN 248091
  • M Health Fairview University of MN Medical Center Hospital, Minneapolis, MN, CCN 240080
  • M Health Fairview Southdale Hospital Hospital, Edina, MN, CCN 240078
  • M Health Fairview St John'S Hospital Hospital, Maplewood, MN, CCN 240210
  • M Health Fairview Woodwinds Hospital Hospital, Woodbury, MN, CCN 240213

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R125822-0MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care CurrentSince Oct 1, 2020 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Clinics CurrentSince May 27, 1997 Accepting new patients
Fairview Clinics CurrentSince May 27, 1997 Accepting new patients
Fairview Express Care CurrentSince Oct 1, 2020 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics Past Accepting new patients

Locations

15650 Cedar Ave
Apple Valley, MN 55124
Phone (952) 997-4100

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

3809 42nd Ave S
Minneapolis, MN 55406
Phone (612) 407-7213

600 W 98th St
Minneapolis, MN 55420
Phone (952) 881-2651

701 25th Ave S
Ste 402
Minneapolis, MN 55454
Phone (612) 672-2900

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

400 Stinson Blvd
#2
Minneapolis, MN 55413
Phone (612) 672-2294

2155 Ford Pkwy
Ste A
Saint Paul, MN 55116
Phone (651) 696-5000

2270 Ford Pkwy
Ste 200
Saint Paul, MN 55116
Phone (651) 696-5000

2155 Ford Pkwy
Saint Paul, MN 55116
Phone (651) 696-5000

Interoperability endpoints

  • Direct secure messaging: jbottem7980@fairview.direct-ci.com

Organizations & group practices 8

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 11

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": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210550400000",
    "number": "1972579464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2155 FORD PKWY",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551161862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2155 FORD PKWY",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551161862",
            "telephone_number": "651-696-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTTEM",
        "first_name": "JENNIFER",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-24",
        "last_updated": "2008-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R125822-0",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.