1. Home
  2. Directory
  3. Minnesota
  4. Saint Paul
  5. Family Medicine
  6. NPI Profile

STILLWATER MEDICAL GROUP MAHTOMEDI
NPI 1861742918
Family Medicine in Saint Paul, MN

Active since September 17, 2012
700 WILDWOOD RD, SAINT PAUL, MN 55115(651) 439-1234(651) 275-3325 Get Directions Write a Review

NPPES record last updated: July 29, 2013. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Stillwater Medical Group Mahtomedi NPPES

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

STILLWATER MEDICAL GROUP MAHTOMEDI (NPI 1861742918) is a healthcare organization registered as a family medicine in Saint Paul, Minnesota and active in the NPI registry since September 2012. The organization lists Ross Bullard, Director Of Finance, as its authorized official.

NPPES Registry Identity

NPI1861742918
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameSTILLWATER MEDICAL GROUP
Location Address700 WILDWOOD RDSaint Paul, MN 55115-1852
Mailing Address1500 Curve Crest BlvdStillwater, MN 55082-6040 · (651) 439-1234
Phone(651) 439-1234
Fax(651) 275-3325
Organization SubpartNo
Authorized OfficialRoss BullardDirector Of Finance · (651) 439-1234
Enumeration DateSeptember 17, 2012
Last NPPES UpdateJuly 29, 2013
✔ NPI 1861742918 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 ListedInternal MedicineTaxonomy 207R00000X
Also ListedPodiatristTaxonomy 213E00000X
700 WILDWOOD RD, Saint Paul, MN 55115
Open in Google Maps ↗

Other Names 1

Doing Business AsStillwater Medical Group Mahtomedi

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

CLIA Laboratory Certificates CMS CLIA 2

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 24D0998210

Stillwater Medical Group · Stillwater, MN
Expired · Apr 8, 2026
CLIA Number24D0998210
Laboratory TypePhysician Office
Certificate Effective DateApril 9, 2024
Certificate Expiration DateApril 8, 2026
Laboratory DirectorJonathan Sellman
Laboratory Phone(651) 439-1234
Laboratory LocationStillwater Medical Group1500 Curve Crest Blvd, Stillwater, MN 55082
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 24D0935436

Stillwater Medical Group Greeley Clinic · Stillwater, MN
Expired · Apr 30, 2026
CLIA Number24D0935436
Laboratory TypePhysician Office
Certificate Effective DateMay 1, 2024
Certificate Expiration DateApril 30, 2026
Laboratory DirectorLaura A. Dean
Laboratory Phone(651) 275-3311
Laboratory LocationStillwater Medical Group Greeley Clinic921 South Greeley Street, Stillwater, MN 55082
CLIA data matches this NPI record on: Name
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 Stillwater Medical Group's NPI number?

The NPI number for Stillwater Medical Group is 1861742918. It was assigned to this organization in the NPPES registry on September 17, 2012.

Where is Stillwater Medical Group located?

Stillwater Medical Group is located at 700 Wildwood Rd, Saint Paul, MN 55115. The listed phone number is (651) 439-1234.

What is Stillwater Medical Group's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Stillwater Medical Group was last updated on July 29, 2013. NPI Profile syncs with the weekly NPPES data releases published by CMS.