PARK NICOLLET CLINIC
NPI 1063897593
Family Medicine in St Louis Park, MN
About Park Nicollet Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PARK NICOLLET CLINIC (NPI 1063897593) is a healthcare organization registered as a family medicine in St Louis Park, Minnesota and active in the NPI registry since July 2015. The organization holds 2 active CLIA laboratory certificates and lists Alita Risinger, Sr Vice President, Cfo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
Other Names 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Park Nicollet Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by January 31, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2,520Medicare enrollment records show 2,520 clinicians reassign Medicare billing to Park Nicollet Clinic, which bills Medicare for the services they deliver. Of these, 254 practice at this address and 1,581 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 67
Nearest to this location (20)
See all 2,520Saint Louis Park, MN 55416
Saint Louis Park, MN 55416
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA 2
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 24D1088674
Park Nicollet Clinic - St Louis Park · Saint Louis Park, MNCertificate of Accreditation 24D0402021
Park Nicollet Clinic - St Louis Park · Saint Louis Park, MNMedical Equipment Supplier Medicare DMEPOS 2
Medicare supplier enrollment and the product categories Park Nicollet Pharmacy #87017 carries, from the Medicare DMEPOS supplier directory.
Park Nicollet Pharmacy #87017
DMEPOS supplier · Saint Louis Park, MNOperated by Group Health Plan IncAccepts Medicare assignment
Park Nicollet Pharmacy #87017 agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Product Categories
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Park Nicollet Clinic's NPI number?
The NPI number for Park Nicollet Clinic is 1063897593. It was assigned to this organization in the NPPES registry on July 27, 2015. The provider is also known as Park Nicollet Clinic Episodic Bundle.
Where is Park Nicollet Clinic located?
Park Nicollet Clinic is located at 3800 Park Nicollet Blvd, St Louis Park, MN 55416. The listed phone number is (952) 993-3123.
What is Park Nicollet Clinic's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Park Nicollet Clinic enrolled in Medicare?
Yes. Park Nicollet Clinic is registered in the Medicare PECOS enrollment system.
When is Park Nicollet Clinic's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Minnesota, Clinic/Group Practice) is due for revalidation by January 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Park Nicollet Clinic?
According to the CMS Revalidation Reassignment List (October 2026 release), 2,520 clinicians in 67 Medicare specialties reassign their Medicare billing to Park Nicollet Clinic. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (312), Family Practice (294) and Physical Therapist in Private Practice (273). Of these, 254 practice at this address and 1,581 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Park Nicollet Clinic accept Medicare assignment for medical equipment?
Yes. As a Medicare medical equipment supplier, Park Nicollet Pharmacy #87017 accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.
Does Park Nicollet Clinic hold CLIA laboratory certificates?
Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.
What insurance does Park Nicollet Clinic accept?
Health plans from HealthPartners list Park Nicollet Clinic as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Park Nicollet Clinic was last updated on August 3, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Park Nicollet Clinic · NPI 1063897593
Family Medicine organization in St Louis Park, Minnesota. Organization record, active in the CMS NPPES registry since July 27, 2015.
## Identity
- **NPI:** 1063897593 (Entity type: Organization)
- **Enumerated:** July 27, 2015
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Also known as:** Park Nicollet Clinic Episodic Bundle (Other Name)
- **Organization subpart:** No
- **Authorized official:** Alita Risinger, SR VICE PRESIDENT, CFO
## Practice location
- **Address:** 3800 PARK NICOLLET BLVD, St Louis Park, MN 55416-2527
- **Phone:** (952) 993-3123 · **Fax:** (952) 993-2770
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** January 31, 2027 (Non-DME Part B, Minnesota, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2,520 clinicians in 67 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (312), Family Practice (294), Physical Therapist in Private Practice (273); 254 practice at this address and 1,581 within 10 miles; [full list](https://npiprofile.com/npi/1063897593/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 3, 2026
- **CLIA laboratory certificates:** 2 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1063897593) · Data from the CMS NPPES public registry.