SALLY H ENGEBRETSON DO
NPI 1316900590
Internal Medicine in Plymouth, MN

Q: What is Sally Engebretson's NPI number?

The NPI number for Sally Engebretson is 1316900590. It was assigned to this individual provider in the NPPES registry on April 10, 2006. The provider is also known as Sally Jeannie Holmes Do.

Q: What is Sally Engebretson's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Q: Is Sally Engebretson enrolled in Medicare?

No. Sally Engebretson has opted out of Medicare through October 2, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

Q: When was this NPI record last updated?

The NPPES record for Sally Engebretson was last updated on November 7, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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 April 10, 2006Opted out of Medicare · through Oct 2, 2027

15655 37TH AVE N STE 100, PLYMOUTH, MN 55446(763) 587-7900(763) 587-7701 Get Directions Write a Review

NPPES record last updated: November 7, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Nov 7, 2022, Oct 20, 2020, Mar 8, 2019 (3 updates tracked since 2019).

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About Sally H Engebretson Do NPPES

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

SALLY H ENGEBRETSON DO (NPI 1316900590) is an individual internal medicine provider in Plymouth, Minnesota, licensed in Minnesota (43959) and active in the NPI registry since April 2006. She has opted out of Medicare through October 2, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1316900590

Entity TypeIndividualFemale

Primary Taxonomy207R00000X

Provider Legal NameSALLY H ENGEBRETSONCredential: DO

Location Address15655 37TH AVE N STE 100Plymouth, MN 55446-4003

Mailing Address9201 W Broadway Ave Ste 601Brooklyn Park, MN 55445-1924 · (763) 587-7900 · Fax (763) 587-7701

Phone(763) 587-7900

Fax(763) 587-7701

Sole ProprietorNo

Enumeration DateApril 10, 2006

Last NPPES UpdateNovember 7, 20223 updates tracked since enumeration

NPPES CertifiedNovember 7, 2022

✔ NPI 1316900590 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

License✔ Licensed in MN · 43959

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

15655 37TH AVE N STE 100, Plymouth, MN 55446

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Other Names 1

Former Name (1)Sally Jeannie Holmes Do

Other Identifiers 1

Medicaid532434300MN

Accepted Insurance

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

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Sally H Engebretson Do has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 2, 2023 through October 2, 2027.

Opt-Out Effective DateOctober 2, 2023

Opt-Out In Effect ThroughOctober 2, 2027Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55446 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

$127.61 typical visit price

range $56.00 – $168.28

Typical copayment $31.90 (range $14.00 – $42.07)

Most-billed visit code 99204

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.

Referred Medical Equipment & Supplies CMS DME claims 3

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

10 suppliers20 claims68 services$5.14 avg. paid by Medicare

Filter, disposable, used with positive airway pressure device A7038

DME-Other DME · category DE001N

2 suppliers11 claims56 services$1.57 avg. paid by Medicare

Continuous positive airway pressure (cpap) device E0601

DME-Other DME · category DE001N

2 suppliers16 claims16 services$24.16 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 16

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

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