Active NPI
James H. Andrisevic, M.D.
- Surgery Physician
- Edina, MN
National Provider Identifier
1053357004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 23231
- Practice address
- 4570 W 77TH St
Suite 235
Edina, MN 55435-5008 - Phone
- (952) 832-0805
- Fax
- (952) 832-5597
- NPI assigned
- Jun 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 23231 | MN | Primary |
Addresses
Primary practice location
4570 W 77TH St
Suite 235
Edina, MN 55435-5008
Mailing address
303 E Nicollet Blvd
Suite 300
Burnsville, MN 55337-4522
Phone (952) 435-4140
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 23231 | Other | MN | MN LICENSE |
| HP12805 | Other | MN | HEALTHPARTNERS |
| 1727004 | Other | MN | MEDICA |
| 25107 | Other | MN | AMERICA'S PPO |
| 138J7AN | Other | MN | BLUECROSS/BLUE SHIELD MN |
| 112126 | Other | MN | UCARE MN |
| 961901000016 | Other | FM | PREFERREDONE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1053357004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "303 E NICOLLET BLVD",
"address_2": "SUITE 300",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553374522",
"telephone_number": "952-435-4140",
"fax_number": "952-435-4189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4570 W 77TH ST",
"address_2": "SUITE 235",
"city": "EDINA",
"state": "MN",
"postal_code": "554355008",
"telephone_number": "952-832-0805",
"fax_number": "952-832-5597"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDRISEVIC",
"first_name": "JAMES",
"middle_name": "H.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-20",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MN",
"license": "23231",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN LICENSE",
"identifier": "23231",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP12805",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "1727004",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICA'S PPO",
"identifier": "25107",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS/BLUE SHIELD MN",
"identifier": "138J7AN",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE MN",
"identifier": "112126",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERREDONE",
"identifier": "961901000016",
"state": "FM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.