Jacob Waxman, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

58490 Issued in MN

Practice address

2355 Highway 36 W Ste 100
Roseville, MN 55113-3905

Phone

(651) 292-2000

NPI assigned

Apr 9, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN, WI, ND3 enrollments

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 3

Specialty

Diagnostic Radiology

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Grand Itasca Clinic and HospitalGroup PAC ID 8123939550, 328 clinicians

Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Pembina County Memorial Hospital AssociationGroup PAC ID 4789643719, 142 clinicians

Altru Health SystemGroup PAC ID 1355251604, 675 clinicians

Lutheran Charity AssociationGroup PAC ID 2264341031, 168 clinicians

Marshfield Clinic IncGroup PAC ID 2264345206, 207 clinicians

Midwest Radiology PAGroup PAC ID 4486568482, 217 clinicians

Ridgeview Medical CenterGroup PAC ID 9234041997, 407 clinicians

Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Midwest Radiology Outpatient Imaging LLCGroup PAC ID 3870495591, 133 clinicians

St. Joseph'S Hospital and Health CenterGroup PAC ID 0547177560, shared by 3 NPIs, 157 clinicians

The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Range Regional Health ServicesGroup PAC ID 8022920024, 349 clinicians

Madison Healthcare ServicesGroup PAC ID 9638080187, 29 clinicians

Suburban Imaging LLCGroup PAC ID 4688564867, 142 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Hospital, Coon Rapids, MN, CCN 240115
• M Health Fairview Southdale Hospital Hospital, Edina, MN, CCN 240078
• M Health Fairview Ridges Hospital Hospital, Burnsville, MN, CCN 240207
• Buffalo Hospital Hospital, Buffalo, MN, CCN 240076
• Chippewa County Hospital Hospital, Montevideo, MN, CCN 241325

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations (25 of 57)

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.

• Fairview Express Care

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1053952606
  Medicare reassignment Care Compare group NPD
• Grand Itasca Clinic and Hospital

  • General Acute Care Hospital
  • Grand Rapids, MN
  • NPI 1669426631
  Medicare reassignment Care Compare group NPD
• Madison Healthcare Services

  • Critical Access Hospital
  • Madison, MN
  • NPI 1942246848
  Medicare reassignment Care Compare group NPD
• Midwest Radiology Outpatient Imaging, LLC

  • Diagnostic Radiology Physician
  • Saint Paul, MN
  • NPI 1720059264
  Medicare reassignment Care Compare group NPD
• Midwest Radiology, PA

  • Diagnostic Radiology Physician
  • Roseville, MN
  • NPI 1952307175

  WI

  Medicare reassignment Care Compare group NPD
• Park Nicollet Clinic

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1780621904
  Medicare reassignment Care Compare group NPD
• Range Regional Health Services

  • Clinic/Center
  • Hibbing, MN
  • NPI 1669569265
  Medicare reassignment Care Compare group NPD
• Ridgeview Medical Center

  • Certified Registered Nurse Anesthetist
  • Waconia, MN
  • NPI 1528364429
  Medicare reassignment Care Compare group NPD
• Suburban Imaging, LLC

  • Radiology Clinic/Center
  • Roseville, MN
  • NPI 1427008937
  Medicare reassignment Care Compare group NPD
• The Duluth Clinic LTD

  • Multi-Specialty Clinic/Center
  • Cloquet, MN
  • NPI 1902563638
  Medicare reassignment Care Compare group NPD
• Altru Health System

  • Clinic/Center
  • Grand Forks, ND
  • NPI 1043309552

  MN

  Medicare reassignment Care Compare group NPD
• Lutheran Charity Association

  • Diagnostic Radiology Physician
  • Jamestown, ND
  • NPI 1700038981

  MN

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Allina Health System

  • Addiction (Substance Use Disorder) Psychologist
  • Fridley, MN
  • NPI 1083197214

  Hospital

  Care Compare affiliation
• Allina Health System

  • General Acute Care Hospital
  • Cambridge, MN
  • NPI 1215755400
  Care Compare affiliation
• Allina Health System

  • Substance Use Disorder Rehabilitation Hospital Unit
  • Fridley, MN
  • NPI 1285692145
  Care Compare affiliation
• Allina Health System

  • General Acute Care Hospital
  • Coon Rapids, MN
  • NPI 1316904287
  Care Compare affiliation
• Allina Health System

  • Radiation Oncology Clinic/Center
  • Buffalo, MN
  • NPI 1417548959

  Hospital

  Care Compare affiliation
• Allina Health System

  • Maternal & Fetal Medicine Physician
  • Coon Rapids, MN
  • NPI 1447527767

  Hospital

  Care Compare affiliation
• Allina Health System

  • General Acute Care Hospital
  • Buffalo, MN
  • NPI 1538123567
  Care Compare affiliation
• Allina Health System

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fridley, MN
  • NPI 1598700528

  Hospital

  Care Compare affiliation
• Allina Health System

  • Psychiatric Hospital Unit
  • Fridley, MN
  • NPI 1609056100
  Care Compare affiliation
• CCM Health

  • Urgent Care Clinic/Center
  • Montevideo, MN
  • NPI 1275057978

  Hospital

  Care Compare affiliation
• CCM Health

  • Critical Access Hospital
  • Montevideo, MN
  • NPI 1720086028
  Care Compare affiliation
• Fairview Health Services

  • General Acute Care Hospital
  • Minneapolis, MN
  • NPI 1013994359
  Care Compare affiliation

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

{
    "created_epoch": "1365465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626912000000",
    "number": "1972946937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2355 HIGHWAY 36 W STE 100",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133905",
            "telephone_number": "651-292-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2355 HIGHWAY 36 W STE 100",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133905",
            "telephone_number": "651-292-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 1st St SW",
            "address_2": "Department of Radiology",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "55905",
            "country_code": "US",
            "telephone_number": "507-293-3680",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAXMAN",
        "first_name": "JACOB",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-09",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "58490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary L Wangen, PA
• Randi Jo Want
• Warby Parker Inc.
• Beth-Anne Joelle Wasemiller, APRN
• Courtland J Watson, OD
• Hugh Richard Wegwerth, D.C.
• Abbigail Wehling, LPCC
• David Armin Weiland, MD
• Robert H Weinmann IV, MD
• Shannon Weinmann

• Diagnostic Radiology Physician in Roseville, MN
• Providers in Roseville, MN by specialty
• Diagnostic Radiology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.