DR. MARY C BLOMBERG MD
NPI 1205813557
Pediatrics in St Louis Park, MN

Q: What is Mary Blomberg's NPI number?

The NPI number for Mary Blomberg is 1205813557. It was assigned to this individual provider in the NPPES registry on December 28, 2005.

Q: What is Mary Blomberg's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Q: When was this NPI record last updated?

The NPPES record for Mary Blomberg was last updated on June 27, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.

Active since December 28, 2005PECOS Enrolled

3850 PARK NICOLLET BLVD, ST LOUIS PARK, MN 55416(952) 993-3298 Get Directions Write a Review

NPPES record last updated: June 27, 2012. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Dr. Mary C Blomberg Md NPPES

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

DR. MARY C BLOMBERG MD (NPI 1205813557) is an individual pediatrics provider in St Louis Park, Minnesota, licensed in Minnesota (41144) and active in the NPI registry since December 2005. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1205813557

Entity TypeIndividualFemale

Primary Taxonomy208000000X

Provider Legal NameDR. MARY C BLOMBERGCredential: MD

Location Address3850 PARK NICOLLET BLVDSt Louis Park, MN 55416-2527

Mailing Address6465 Wayzata Blvd, Ste 315St Louis Park, MN 55426-1728

Phone(952) 993-3298

Sole ProprietorNo

Enumeration DateDecember 28, 2005

Last NPPES UpdateJune 27, 2012

✔ NPI 1205813557 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

License✔ Licensed in MN · 41144

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

3850 PARK NICOLLET BLVD, St Louis Park, MN 55416

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Other Identifiers 3

Medicaid753224500MN

Medicare UPING89806MN

Medicare ID-Type UnspecifiedG89806MN

Accepted Insurance

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

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Mary C Blomberg Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Mary Blomberg reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Park Nicollet Methodist Hospital

Same address

General Acute Care Hospital

3900 PARK NICOLLET BLVD
St Louis Park, MN 55416

Reassigned Medicare billing, Minnesota enrollment
Medicare enrollment name: Park Nicollet Clinic
2,527 clinicians in this Medicare group

NPI 1194113217 (952) 993-1953

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55416 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.82 typical visit price

range $56.00 – $168.28

Typical copayment $21.45 (range $14.00 – $42.07)

Most-billed visit code 99203

Established Patient

$98.61 typical visit price

range $18.32 – $138.04

Typical copayment $24.65 (range $4.58 – $34.51)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

ELISABETH JEAN MCCLEAN MD

Family Medicine