Individual provider Active NPI

Bruce Ira Idelkope, M.D.

  • Neurology Physician
  • Edina, MN
National Provider Identifier
1083661680
Registry record updated Dec 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
22536 Issued in MN
Practice address
3400 W 66TH St
Suite 150
Edina, MN 55435-2109
Phone
(952) 920-7200
Fax
(763) 302-4234
NPI assigned
May 28, 2006
Last updated
Dec 2, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 22536 MN Primary

Addresses

Primary practice location

3400 W 66TH St
Suite 150
Edina, MN 55435-2109

Mailing address

3400 W 66TH St
Suite 150
Edina, MN 55435-2109
Phone (952) 920-7200

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
I20100306000239 MN Practitioner - Neurology 6800977240 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
88.63 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
22536MNMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Express Care CurrentSince May 1, 2020 Accepting new patients
Fairview Express Care CurrentSince Jun 6, 2020 Accepting new patients
Fairview Health Services CurrentSince May 1, 2020 Accepting new patients
Fairview Express Care CurrentSince Jun 6, 2020 Accepting new patients
Laboratory Corportation of America Holdings Past Accepting new patients

Locations

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

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

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

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

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

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

Organizations & group practices 8

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

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322784000000",
    "number": "1083661680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 W 66TH ST",
            "address_2": "SUITE 150",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352109",
            "telephone_number": "952-920-7200",
            "fax_number": "763-302-4234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 W 66TH ST",
            "address_2": "SUITE 150",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352109",
            "telephone_number": "952-920-7200",
            "fax_number": "763-302-4234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDELKOPE",
        "first_name": "BRUCE",
        "middle_name": "IRA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-28",
        "last_updated": "2011-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MN",
            "license": "22536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.