Individual provider Active NPI

Viet Pham, M.D.

  • Internal Medicine Physician
  • Maple Grove, MN
National Provider Identifier
1104087493
Registry record updated Jan 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
54552 Issued in MN
Practice address
9875 Hospital Dr
Maple Grove, MN 55369-4648
Phone
(763) 581-1000
NPI assigned
Jun 19, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 54552 MN Primary

Addresses

Primary practice location

9875 Hospital Dr
Maple Grove, MN 55369-4648

Mailing address

9875 Hospital Dr
Maple Grove, MN 55369-4648
Phone (763) 581-1000

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
I20110816000544 MN Practitioner - Internal Medicine 7315116969 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Minnesota Medical School, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Memorial Health CareGroup PAC ID 0042123028, 502 clinicians

Practice addresses (Care Compare)

3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone (763) 581-5400

9855 Hospital Dr
Maple Grove, MN 55369-4648

9875 Hospital Dr
Maple Grove, MN 55369-4648
Phone (763) 581-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
54552MNMDInternal Medicine Physician
105486MNMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
North Memorial Health Care Current Accepting new patients
North Memorial Health Care CurrentSince Jul 1, 2016 Accepting new patients
North Memorial Health Care Past Accepting new patients

Locations

9875 Hospital Dr
Maple Grove, MN 55369
Phone (763) 581-1000

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

Organizations & group practices 3

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 5

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": "1213833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390780800000",
    "number": "1104087493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9875 HOSPITAL DR",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694648",
            "telephone_number": "763-581-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9875 HOSPITAL DR",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694648",
            "telephone_number": "763-581-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "VIET",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-19",
        "last_updated": "2014-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "54552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.