NPIMap

Organization Active NPI

Park Nicollet Health Care Products

  • Durable Medical Equipment & Medical Supplies
  • St Louis Park, MN
National Provider Identifier
1992768899
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PARK NICOLLET HEALTH CARE PRODUCTS
Practice address
3931 Louisiana Ave S
St Louis Park, MN 55426-4375
Phone
(952) 993-3121
Fax
(952) 993-0562
NPI assigned
Apr 11, 2006
Organization subpart
Yes
Parent organization
PARK NICOLLET HEALTH SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Authorized official

Name
Kristin Denise Brey
Title
Supervisor/Delegated Official
Phone
(952) 993-6832

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

3931 Louisiana Ave S
St Louis Park, MN 55426-4375

Mailing address

3800 Park Nicollet Blvd # Ms 61901C
St Louis Park, MN 55416-2527

Other identifiers 2

IdentifierTypeStateIssuer
2418691OtherNCPDP PROVIDER INDENTIFICATION NUMBER
339084500MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930006897 MN DME Supplier - Medical Supply CompanyDME Supplier - Medical Supply Company With Orthotic-ProstheticDME Supplier - OpticianDME Supplier - Medical Supply Company With Pedorthic Personnel 2365655164 1 other NPI on this enrollment
Practice locations: St Louis Park, MN

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Park Nicollet Health Care Products3931 Louisiana S Ave, St Louis Park, MN 55426-5000(952) 993-5928 Commodes, Urinals, Bedpans|Negative Pressure Wound Therapy Pumps/Supplies|Pneumatic Compression Devices and/or Supplies|Speech Generating Devices|Traction Equipment|Ultraviolet Light Devices and/or Supplies|Canes and/or Crutches|Walkers|Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custo… Does not accept assignmentParticipating since Jul 1, 2002

National Provider Directory

National Provider Directory
Tax ID family
Park Nicollet10 organizations share this tax ID, including this one
Part of
Park Nicollet

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1992768899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 PARK NICOLLET BLVD # MS 61901C",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162527",
            "fax_number": "952-993-0562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3931 LOUISIANA AVE S",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264375",
            "telephone_number": "952-993-3121",
            "fax_number": "952-993-0562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK NICOLLET HEALTH CARE PRODUCTS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PARK NICOLLET HEALTH SERVICES",
        "enumeration_date": "2006-04-11",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "BREY",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "SUPERVISOR/DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "952-993-6832"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER INDENTIFICATION NUMBER",
            "identifier": "2418691",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "339084500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.