Individual provider Active NPI

Jessica Eliza Sukharan, MD

  • Student in an Organized Health Care Education/Training Program
  • Minneapolis, MN
National Provider Identifier
1003557794
Registry record updated Apr 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
2020 E 28TH St Ste 104
Minneapolis, MN 55407-1925
Phone
(763) 330-0770
NPI assigned
Apr 5, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 5, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

2020 E 28TH St Ste 104
Minneapolis, MN 55407-1925

Mailing address

2020 E 28TH St Ste 104
Minneapolis, MN 55407-1925
Phone (763) 330-0770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251219001538 MN Practitioner - Family Practice 8729461462 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

10000 Zane Ave N
Brooklyn Park, MN 55443-1400
Phone (763) 572-5700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Clinics CurrentSince Nov 10, 2025 Accepting new patients
Fairview Clinics CurrentSince Nov 10, 2025 Accepting new patients
Fairview Clinics Past Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

10000 Zane Ave N
Minneapolis, MN 55443
Phone (763) 528-6999

2020 E 28th St
Ste 104
Minneapolis, MN 55407
Phone (612) 333-0770

Interoperability endpoints

  • Direct secure messaging: jsukharan454421@fairview.direct-ci.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1003557794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 E 28TH ST STE 104",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071925",
            "telephone_number": "763-330-0770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 E 28TH ST STE 104",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071925",
            "telephone_number": "763-330-0770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUKHARAN",
        "first_name": "JESSICA",
        "middle_name": "ELIZA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-05",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.