1. Home
  2. Directory
  3. Minnesota
  4. St Louis Park
  5. Nurse Practitioner
  6. NPI Profile

PAIN SPECIALIST OF MINNESOTA
NPI 1508562240
Nurse Practitioner - Family in St Louis Park, MN

Active since February 03, 2023CLIA 24D2286335 · Waiver
5810 EXCELSIOR BLVD, ST LOUIS PARK, MN 55416(612) 235-6008(612) 235-6003 Get Directions Write a Review

NPPES record last updated: January 22, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Dec 26, 2024, Feb 19, 2023, Feb 3, 2023 (3 updates tracked since 2023).

About Pain Specialist Of Minnesota NPPES

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

PAIN SPECIALIST OF MINNESOTA (NPI 1508562240) is a healthcare organization registered as a family in St Louis Park, Minnesota and active in the NPI registry since February 2023. The organization holds a CLIA Waiver certificate valid through July 26, 2027 and lists Mark Stock, Ceo, as its authorized official.

NPPES Registry Identity

NPI1508562240
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NamePAIN SPECIALIST OF MINNESOTA
Location Address5810 EXCELSIOR BLVDSt Louis Park, MN 55416-2830
Mailing Address5810 Excelsior BlvdSt Louis Park, MN 55416-2830 · (612) 235-6008 · Fax (612) 235-6003
Phone(612) 235-6008
Fax(612) 235-6003
Organization SubpartNo
Authorized OfficialMark StockCeo · (651) 238-8580
Enumeration DateFebruary 3, 2023
Last NPPES UpdateJanuary 22, 20253 updates tracked since enumeration
NPPES CertifiedJanuary 22, 2025
✔ NPI 1508562240 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
5810 EXCELSIOR BLVD, St Louis Park, MN 55416
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Pain Specialist Of Minnesota is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Pain Specialist Of Minnesota, which bills Medicare for the services this clinician delivers.

Clinician (1)

Mark Stock, NP-C
Nurse Practitioner
NPI 1962634154
5810 EXCELSIOR BLVD
St Louis Park, MN 55416
(612) 235-6008
✔ PECOS✔ Accepts MedicareSame address

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

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 24D2286335

Pain Specialist Of Minnesota · Saint Louis Park, MN
Active · expires Jul 26, 2027
CLIA Number24D2286335
Laboratory TypePhysician Office
Certificate Effective DateJuly 27, 2025
Certificate Expiration DateJuly 26, 2027
Laboratory DirectorMark J. Stock
Laboratory Phone(612) 235-6008
Laboratory LocationPain Specialist Of Minnesota5810 Excelsior Blvd, Saint Louis Park, MN 55416
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Pain Specialist Of Minnesota's NPI number?

The NPI number for Pain Specialist Of Minnesota is 1508562240. It was assigned to this organization in the NPPES registry on February 3, 2023.

Where is Pain Specialist Of Minnesota located?

Pain Specialist Of Minnesota is located at 5810 Excelsior Blvd, St Louis Park, MN 55416. The listed phone number is (612) 235-6008.

What is Pain Specialist Of Minnesota's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Pain Specialist Of Minnesota enrolled in Medicare?

Yes. Pain Specialist Of Minnesota is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Pain Specialist Of Minnesota?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Pain Specialist Of Minnesota. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Pain Specialist Of Minnesota hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D2286335) is associated with this NPI, valid through July 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Pain Specialist Of Minnesota was last updated on January 22, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 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.