NPIMap

Individual provider Active NPI

Scott Edward Wavinak, D.O.

  • Family Medicine Physician
  • Prior Lake, MN
National Provider Identifier
1063831733
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
60135 Issued in MN
Practice address
4151 Willowwood St SE
Prior Lake, MN 55372-4304
Phone
(952) 226-2600
NPI assigned
Apr 10, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 60135 MN Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

4151 Willowwood St SE
Prior Lake, MN 55372-4304

Mailing address

4151 Willowwood St SE
Prior Lake, MN 55372-4304

Other practice location 1

701 Park Avenue
Hennepin County Medical Center - Family Medicine
Minneapolis, MN 55415
Phone (612) 702-6102

Other practice location 2

5725 Loftus Lane
Savage, MN 55378-2717
Phone (952) 226-9500

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170718003544 MN Practitioner - Family Practice 9739488669 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2014
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)

15075 Cimarron Ave
Rosemount, MN 55068-1635
Phone (651) 322-8800

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
60135MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services CurrentSince Dec 1, 2022 Accepting new patients
Fairview Express Care CurrentSince Dec 1, 2022 Accepting new patients
Fairview Health Services CurrentSince Dec 1, 2022 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Express Care CurrentSince Dec 1, 2022 Accepting new patients
Fairview Clinics CurrentSince Aug 11, 2017 Accepting new patients
Fairview Clinics CurrentSince Aug 11, 2017 Accepting new patients
Fairview Clinics Past Accepting new patients

Locations

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

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

400 Stinson Blvd
Minneapolis, MN 55413
Phone (612) 672-2258

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

4151 Willowwood St SE
Prior Lake, MN 55372
Phone (952) 226-2600

15075 Cimarron Ave
Rosemount, MN 55068
Phone (651) 322-8800

5725 Loftus Ln
Savage, MN 55378
Phone (952) 226-9500

Interoperability endpoints

  • Direct secure messaging: swavinak392222@fairview.direct-ci.com

Organizations & group practices 11

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1397088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1063831733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4151 WILLOWWOOD ST SE",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553724304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4151 WILLOWWOOD ST SE",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553724304",
            "telephone_number": "952-226-2600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Park Avenue",
            "address_2": "Hennepin County Medical Center - Family Medicine",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "55415",
            "country_code": "US",
            "telephone_number": "612-702-6102",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5725 Loftus Lane",
            "address_purpose": "LOCATION",
            "city": "Savage",
            "state": "MN",
            "postal_code": "553782717",
            "country_code": "US",
            "telephone_number": "952-226-9500",
            "fax_number": "952-226-9501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAVINAK",
        "first_name": "SCOTT",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-10",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "60135",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prior Lake, MN

Sources for this page

Verify at the official NPI Registry.