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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

PARK NICOLLET CLINIC
NPI 1063897593
Family Medicine in St Louis Park, MN

Active since July 27, 2015CLIA Certified · 5 labs
3800 PARK NICOLLET BLVD, ST LOUIS PARK, MN 55416(952) 993-3123(952) 993-2770 Get Directions Write a Review

NPPES record last updated: August 3, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Aug 3, 2026, Sep 9, 2019 (2 updates tracked since 2019).

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 5 active CLIA laboratory certificates and lists Alita Risinger, Sr Vice President, Cfo, as its authorized official.

NPPES Registry Identity

NPI1063897593
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NamePARK NICOLLET CLINIC
Location Address3800 PARK NICOLLET BLVDSt Louis Park, MN 55416-2527
Mailing Address3800 Park Nicollet Blvd, Attention: Business ServicesSt Louis Park, MN 55416-2527 · (952) 993-1000
Phone(952) 993-3123
Fax(952) 993-2770
Organization SubpartNo
Authorized OfficialAlita RisingerSr Vice President, Cfo · (952) 883-5401
Enumeration DateJuly 27, 2015
Last NPPES UpdateAugust 3, 20262 updates tracked since enumeration
NPPES CertifiedAugust 3, 2026
✔ NPI 1063897593 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedObstetrics & GynecologyTaxonomy 207V00000X
Also ListedPediatricsTaxonomy 208000000X
3800 PARK NICOLLET BLVD, St Louis Park, MN 55416
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners.Insurance ›

CLIA Laboratory Certificates CMS CLIA 5

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 24D0984755

Park Nicollet Clinic - Creekside · Saint Louis Park, MN
Active · expires Feb 16, 2028
CLIA Number24D0984755
Laboratory TypePhysician Office
Certificate Effective DateFebruary 17, 2026
Certificate Expiration DateFebruary 16, 2028
Laboratory DirectorIan L. Gunsolus
Laboratory Phone(952) 993-6513
Laboratory LocationPark Nicollet Clinic - Creekside6600 Excelsior Blvd, #160, Saint Louis Park, MN 55426
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Accreditation 24D0402021

Park Nicollet Clinic - St Louis Park · Saint Louis Park, MN
Active · expires Jun 6, 2027
CLIA Number24D0402021
Laboratory TypePhysician Office
Certificate Effective DateJune 7, 2025
Certificate Expiration DateJune 6, 2027
Laboratory DirectorDr. Laura E. Moench
Laboratory Phone(952) 993-3270
Laboratory LocationPark Nicollet Clinic - St Louis Park3850 Park Nicollet Boulevard, Saint Louis Park, MN 55416
CLIA data matches this NPI record on: Name
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate of Waiver 24D1088673

Park Nicollet Clinic - St Louis Park · Saint Louis Park, MN
Active · expires Sep 1, 2026
CLIA Number24D1088673
Laboratory TypeMobile Laboratory
Certificate Effective DateSeptember 2, 2024
Certificate Expiration DateSeptember 1, 2026
Laboratory DirectorApryl Starcznski
Laboratory Phone(952) 993-0970
Laboratory LocationPark Nicollet Clinic - St Louis Park3800 Park Nicollet Blvd, Saint Louis Park, MN 55416
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 24D1088674

Park Nicollet Clinic - St Louis Park · Saint Louis Park, MN
Active · expires Sep 1, 2026
CLIA Number24D1088674
Laboratory TypeMobile Laboratory
Certificate Effective DateSeptember 2, 2024
Certificate Expiration DateSeptember 1, 2026
Laboratory DirectorNathan Lueck
Laboratory Phone(952) 993-3128
Laboratory LocationPark Nicollet Clinic - St Louis Park3900 Park Nicollet Blvd, Saint Louis Park, MN 55416
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 24D1088675

Park Nicollet Clinic - Womens Center 5th Floor · Saint Louis Park, MN
Active · expires Sep 1, 2026
CLIA Number24D1088675
Laboratory TypePhysician Office
Certificate Effective DateSeptember 2, 2024
Certificate Expiration DateSeptember 1, 2026
Laboratory DirectorAmy M. West
Laboratory Phone(952) 993-0415
Laboratory LocationPark Nicollet Clinic - Womens Center 5th Floor6500 Excelsior Blvd - Suite 500, Saint Louis Park, MN 55426
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Medical 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 Inc
✔

Accepts 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.

PTAN (Medicare Supplier Number)20667845
Medicare Participant SinceJanuary 1, 1996
Supplier Location3800 Park Nicollet Blvd Ste 1170Saint Louis Park, MN 55416
Phone(952) 977-3050
Provider TypeMulti-Specialty - Physician
Supplier Specialties
Pharmacy

Medicare Product Categories

Oral Anticancer Drugs
FDA anticancer drugs
Oral Antiemetic Drugs
FDA antiemetic drugs
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PETER MCCORMICK SCHAUB PSYD, LP
Psychologist
3800 PARK NICOLLET BLVD
ST LOUIS PARK, MN 55416
Hennepin County (952) 993-3123
DAVID J NUTZ MD
Physical Medicine & Rehabilitation
3800 PARK NICOLLET BLVD
ST LOUIS PARK, MN 55416
Hennepin County (952) 993-3800
GLENN MATFIN M.D.
Internal Medicine (Endocrinology, Diabetes & Metabolism)
3800 PARK NICOLLET BLVD
MINNEAPOLIS, MN 55416
Hennepin County (952) 993-3048
KELLY C GRECO PAC
Physician Assistant
3800 PARK NICOLLET BLVD, DEPARTMENT OF DERMATOLOGY
ST LOUIS PARK, MN 55416
Hennepin County (952) 993-3260
KARLA SUSAN ROSENMAN MD
Dermatology
3800 PARK NICOLLET BLVD, DERMATOLOGY 4TH FLOOR
ST LOUIS PARK, MN 55416
Hennepin County (952) 993-3821
DR. KRISTIN A KUNZMAN PSY.D.
Psychologist (Clinical)
3800 PARK NICOLLET BLVD
ST LOUIS PARK, MN 55416
Hennepin County (952) 993-3393
DR. ALISON M LANG M.D.
Dermatology
3800 PARK NICOLLET BLVD
ST LOUIS PARK, MN 55416
Hennepin County (952) 993-3789
DR. CHUNG M LEE M.D.
Radiology (Diagnostic Radiology)
3800 PARK NICOLLET BLVD
ST LOUIS PARK, MN 55416
Hennepin County (952) 993-3212

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.

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.

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. 5 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 18 days 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.