Active NPI
Fairview Health Services
- Prosthetic/Orthotic Supplier
- Woodbury, MN
National Provider Identifier
1104392398
On this page
- Key facts
- Authorized official
- Corporate family (same tax ID)17
- Laboratory certificates & supplier records
- Medicare participation
- All facility ownership & control disclosures4
- Medicare enrollment records1
- National Provider Directory
- Specialties & licenses1
- Addresses
- Other names2
- NPI Registry JSON
- Other providers in Woodbury, MN
- Sources for this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- Legal business name
- FAIRVIEW HEALTH SERVICES
- Practice address
- 1875 Woodwinds Dr Ste 150
Woodbury, MN 55125-2518 - Phone
- (651) 683-7000
- Fax
- (651) 683-7001
- NPI assigned
- Oct 16, 2018
- Organization subpart
- No
Authorized official
NPPES NPI Registry- Name
- Jill Marie McCartney
- Title
- System Executive HME O&P
- Phone
- (651) 632-9835
Corporate family (same tax ID) 17
Organizations that report the same tax identification number in the National Provider Directory.
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- Durable Medical Equipment & Medical Supplies
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Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Fairview Health Services | Neuromuscular Elect Stimulators (NMES)/Supplies|Osteogenesis Stimulators|Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Breast Prostheses and/or Accessories|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Com… | Accepts assignment |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
All facility ownership & control disclosures 4
Medicare enrollment filesFacilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Capitol Park Mental Health Hospital | Hospital | 5% Or Greater Direct Ownership Interest (12.1%) | Dec 7, 2021 |
| Accentcare Fairview Home Health - East, LLC | Home health agency | 5% Or Greater Indirect Ownership Interest (20%) | Nov 2, 2020 |
| Accentcare Fairview Home Health - West, LLC | Home health agency | 5% Or Greater Indirect Ownership Interest (20%) | Nov 2, 2020 |
| Accentcare Fairview Hospice - West, LLC | Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Nov 2, 2020 |
Medicare enrollment records 1
Medicare enrollment files| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190423002696 | MN | DME Supplier - Medical Supply Company With Orthotic-Prosthetic | 1951213057 | Practice locations: Woodbury, MN |
National Provider Directory
National Provider Directory- Tax ID family
- Mesaba Clinic
Specialties & licenses 1
NPPES NPI Registry| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | Primary |
Addresses
NPPES NPI RegistryPrimary practice location
1875 Woodwinds Dr Ste 150
Woodbury, MN 55125-2518
Mailing address
1700 University Ave W
Saint Paul, MN 55104-3727
Phone (612) 672-6740
Other names 2
NPPES NPI Registry- Fairview Woodbury Orthotics and Prosthetics
- M Health Fairview Orthotics and Prosthetics Woodwinds
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 23, 2026.
{
"created_epoch": "1539648000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1784764800000",
"number": "1104392398",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1700 UNIVERSITY AVE W",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551043727",
"telephone_number": "612-672-6740",
"fax_number": "612-884-3592"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1875 WOODWINDS DR STE 150",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551252518",
"telephone_number": "651-683-7000",
"fax_number": "651-683-7001"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FAIRVIEW HEALTH SERVICES",
"organizational_subpart": "NO",
"enumeration_date": "2018-10-16",
"last_updated": "2026-07-23",
"certification_date": "2026-07-23",
"status": "A",
"authorized_official_last_name": "MCCARTNEY",
"authorized_official_first_name": "JILL",
"authorized_official_middle_name": "MARIE",
"authorized_official_title_or_position": "SYSTEM EXECUTIVE HME O&P",
"authorized_official_telephone_number": "651-632-9835"
},
"taxonomies": [
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Fairview Woodbury Orthotics and Prosthetics",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "M Health Fairview Orthotics and Prosthetics Woodwinds",
"code": "5",
"type": "Other Name"
}
]
}
Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.