NPIMap

Individual provider Active NPI

Sandra Joanne Schultz, M.D.

  • Internal Medicine Physician
  • Champlin, MN
National Provider Identifier
1982848503
Registry record updated Apr 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
55778 Issued in MN
Practice address
12142 Business Park Blvd N
Champlin, MN 55316-4525
Phone
(952) 977-0500
Fax
(952) 977-0510
NPI assigned
Apr 27, 2009
Last updated
Apr 5, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 55778 MN
Internal Medicine Physician 207R00000X 55778 MN Primary

Addresses

Primary practice location

12142 Business Park Blvd N
Champlin, MN 55316-4525

Mailing address

12142 Business Park Blvd N
Champlin, MN 55316-4525
Phone (952) 977-0500

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
I20131011000442 MN Practitioner - Internal MedicinePractitioner - Pediatric Medicine 0840424594 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
University of Minnesota Medical School, 2009
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)

12142 Business Park Blvd N
Champlin, MN 55316-4525
Phone (952) 977-0500

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

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Pediatrics CurrentSince Oct 14, 2013 Accepting new patients
Park Nicollet Clinic Pediatrics CurrentSince Oct 14, 2013 Accepting new patients
Maple Grove Hospital Corporation Past Accepting new patients

Locations

12142 Business Park Blvd N
Champlin, MN 55316
Phone (952) 977-0500

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

Organizations & group practices 3

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 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1240790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459814400000",
    "number": "1982848503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12142 BUSINESS PARK BLVD N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553164525",
            "telephone_number": "952-977-0500",
            "fax_number": "952-977-0510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12142 BUSINESS PARK BLVD N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553164525",
            "telephone_number": "952-977-0500",
            "fax_number": "952-977-0510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHULTZ",
        "first_name": "SANDRA",
        "middle_name": "JOANNE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-27",
        "last_updated": "2016-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "55778",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "55778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champlin, MN

Sources for this page

Verify at the official NPI Registry.