Individual provider Active NPI

George Randall Wandling Jr., MD

  • Ophthalmology Physician
  • Coon Rapids, MN
National Provider Identifier
1083935068
Registry record updated Jan 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
59282 Issued in MN
Practice address
3777 Coon Rapids Blvd NW # 100
Coon Rapids, MN 55433-2630
Phone
(763) 421-7420
NPI assigned
Jun 14, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 41882 IA
Ophthalmology Physician 207W00000X 036137863 IL
Ophthalmology Physician 207W00000X 59282 MN Primary

Addresses

Primary practice location

3777 Coon Rapids Blvd NW # 100
Coon Rapids, MN 55433-2630

Mailing address

3777 Coon Rapids Blvd NW # 100
Coon Rapids, MN 55433-2630
Phone (763) 421-7420

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20161115000674 MN Practitioner - Ophthalmology 1557587938 Reassigns benefits to 2 organizations
I20161213001575 WI Practitioner - Ophthalmology 1557587938 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
University of Iowa, RJ & L Carver College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Croix Regional Medical CenterGroup PAC ID 9335032184, 131 clinicians

Practice addresses (Care Compare)

12375 Lindstrom LN
Lindstrom, MN 55045-9551
Phone (651) 400-2240

235 E State St
St Croix Falls, WI 54024-4117

235 State St
St Croix Falls, WI 54024-4117

3777 Coon Rapids Blvd NW
Suite 100
Coon Rapids, MN 55433-2630
Phone (763) 421-7420

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.52 of 100Reported as group
Quality
80.37
Promoting interoperability
96
Improvement activities
40
Cost
74.71

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery312

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41882IAMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Croix Regional Medical Center CurrentSince Jan 1, 2017 Accepting new patients
Edina Eye Physicians and Surgeons PA Ophthalmology CurrentSince Jan 1, 2019 Accepting new patients
Edina Eye Physicians and Surgeons PA Ophthalmology CurrentSince Jan 1, 2019 Accepting new patients
Edina Eye Physicians and Surgeons PA Ophthalmology Current Accepting new patients
St. Croix Regional Medical Center CurrentSince Jan 1, 2017 Accepting new patients

Locations

11855 Ulysses St NE
Ste 140
Blaine, MN 55434
Phone (763) 421-7420

7450 France Ave S
Ste 100
Minneapolis, MN 55435
Phone (952) 832-8100

3777 Coon Rapids Blvd NW
Ste 100
Minneapolis, MN 55433
Phone (763) 421-7420

4520 Centerville Rd
White Bear Lk, MN 55127
Phone (651) 426-1141

216 S Adams St
St Croix Fls, WI 54024
Phone (715) 483-0426

235 E State St
St Croix Fls, WI 54024
Phone (715) 483-3221

Interoperability endpoints

  • Direct secure messaging: gwandling177998@excellian.direct.allina.com

Organizations & group practices 5

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 1

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": "1276473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485820800000",
    "number": "1083935068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3777 COON RAPIDS BLVD NW # 100",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332630",
            "telephone_number": "763-421-7420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3777 COON RAPIDS BLVD NW # 100",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332630",
            "telephone_number": "763-421-7420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANDLING",
        "first_name": "GEORGE",
        "middle_name": "RANDALL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-14",
        "last_updated": "2017-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IA",
            "license": "41882",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036137863",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "59282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coon Rapids, MN

Sources for this page

Verify at the official NPI Registry.