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PARK NICOLLET
NPI 1174975528
Clinic/Center in Maple Grove, MN

Active since July 11, 2016CLIA Certified · 3 labs
9555 UPLAND LN N, MAPLE GROVE, MN 55369(952) 993-1440 Get Directions Write a Review

NPPES record last updated: July 11, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Park Nicollet NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PARK NICOLLET (NPI 1174975528) is a healthcare organization registered as a clinic/center in Maple Grove, Minnesota and active in the NPI registry since July 2016. The organization holds 3 active CLIA laboratory certificates and lists Bernt Helgaas, Medical Director Park Nicollet Mgrc, as its authorized official.

NPPES Registry Identity

NPI1174975528
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NamePARK NICOLLET
Location Address9555 UPLAND LN NMaple Grove, MN 55369-4485
Mailing Address7102 Olive Ln NMaple Grove, MN 55311-3573 · (763) 494-4686
Phone(952) 993-1440
Organization SubpartNo
Authorized OfficialBernt HelgaasMedical Director Park Nicollet Mgrc · (952) 993-1440
Enumeration DateJuly 11, 2016
✔ NPI 1174975528 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
9555 UPLAND LN N, Maple Grove, MN 55369
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CLIA Laboratory Certificates CMS CLIA 4

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 Accreditation 24D2072751

Park Nicollet Dermatology Department Maple Grove · Maple Grove, MN
Active · expires Sep 5, 2027
CLIA Number24D2072751
Laboratory TypePhysician Office
Certificate Effective DateSeptember 6, 2025
Certificate Expiration DateSeptember 5, 2027
Laboratory DirectorDr. Erick Jacobson-Dunlop
Laboratory Phone(952) 993-1141
Laboratory LocationPark Nicollet Dermatology Department Maple Grove9555 Upland Lane North, Maple Grove, MN 55369
CLIA data matches this NPI record on: Address 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 Accreditation 24D0960663

Park Nicollet Clinic And Specialty Center · Maple Grove, MN
Active · expires Oct 9, 2026
CLIA Number24D0960663
Laboratory TypePhysician Office
Certificate Effective DateOctober 10, 2024
Certificate Expiration DateOctober 9, 2026
Laboratory DirectorDr. Jason C. Carvalho
Laboratory Phone(952) 993-1448
Laboratory LocationPark Nicollet Clinic And Specialty Center9555 Upland Lane North, Maple Grove, MN 55369
CLIA data matches this NPI record on: Address 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 24D2112635

Park Nicollet Surgery Center · Maple Grove, MN
Active · expires May 3, 2028
CLIA Number24D2112635
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateMay 4, 2026
Certificate Expiration DateMay 3, 2028
Laboratory DirectorJason Carvalho
Laboratory Phone(952) 977-1052
Laboratory LocationPark Nicollet Surgery Center15800 95th Ave North, Maple Grove, MN 55369
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 24D2040494

Park Nicollet Clinic - Maple Grove Ob · Maple Grove, MN
Expired · Jul 31, 2026
CLIA Number24D2040494
Laboratory TypeAncillary Testing Site In Health Care Center
Certificate Effective DateAugust 1, 2024
Certificate Expiration DateJuly 31, 2026
Laboratory DirectorJason Carvalho
Laboratory Phone(952) 977-0220
Laboratory LocationPark Nicollet Clinic - Maple Grove Ob9855 Hospital Drive Suite 275, Maple Grove, MN 55369
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

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.

MICHELLE K. PEMBLE-FRAZEY PHD
Psychologist (Cognitive & Behavioral)
9555 UPLAND LN N
MAPLE GROVE, MN 55369
Hennepin County (952) 993-1440
MRS. REBEKKA MCCLURE MA, LMFT
Marriage & Family Therapist
9555 UPLAND LN N
MAPLE GROVE, MN 55369
Hennepin County (952) 993-1440
NATASHA MARIE MILLS
Psychologist
9555 UPLAND LN N
MAPLE GROVE, MN 55369
Hennepin County (952) 993-1440
NICKOLAS WILLIAMS
Psychiatry & Neurology (Psychiatry)
9555 UPLAND LN N
MAPLE GROVE, MN 55369
Hennepin County (952) 993-1440
REANN JO MCGUIRE DNP, APRN, FNP-C
Nurse Practitioner (Family)
9555 UPLAND LN N
MAPLE GROVE, MN 55369
Hennepin County (952) 993-1440
DANIEL KEELEY MD
Internal Medicine
9555 UPLAND LN N
MAPLE GROVE, MN 55369
Hennepin County (952) 993-1440
DR. MICHAEL H FARRELL MD
Pediatrics
9555 UPLAND LN N
MAPLE GROVE, MN 55369
Hennepin County (952) 993-1440
TARA BARRACK PA-C
Physician Assistant (Surgical)
9555 UPLAND LN N
MAPLE GROVE, MN 55369
Hennepin County (952) 993-1440

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's NPI number?

The NPI number for Park Nicollet is 1174975528. It was assigned to this organization in the NPPES registry on July 11, 2016.

Where is Park Nicollet located?

Park Nicollet is located at 9555 Upland Ln N, Maple Grove, MN 55369. The listed phone number is (952) 993-1440.

What is Park Nicollet's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Does Park Nicollet hold CLIA laboratory certificates?

Yes. 3 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.

When was this NPI record last updated?

The NPPES record for Park Nicollet was last updated on July 11, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years 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.