Individual provider Active NPI

Niveditha Jagadesh

  • Student in an Organized Health Care Education/Training Program
  • Minneapolis, MN
National Provider Identifier
1114663325
Registry record updated Dec 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
420 Delaware Street SE, MMC 195
Minneapolis, MN 55455
Phone
(612) 625-6483
NPI assigned
May 10, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

420 Delaware Street SE, MMC 195
Minneapolis, MN 55455

Mailing address

420 Delaware Street SE, MMC 195
Minneapolis, MN 55455

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
I20250929000282 MN Practitioner - General Surgery 2769863042 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Ohio State University College of Medicine, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1700 University Ave W
FL 6
Saint Paul, MN 55104-3727

420 Delaware St SE MMC
Minneapolis, MN 55455-0302

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services CurrentSince Oct 1, 2025 Accepting new patients
Fairview Health Services CurrentSince Oct 1, 2025 Accepting new patients

Locations

420 Delaware St SE
Ste 195
Minneapolis, MN 55455
Phone (612) 301-9433

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

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

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

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

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.

NPI Registry JSON

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

{
    "created_epoch": "1652140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734220800000",
    "number": "1114663325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 DELAWARE STREET SE, MMC 195",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 DELAWARE STREET SE, MMC 195",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55455",
            "telephone_number": "612-625-6483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAGADESH",
        "first_name": "NIVEDITHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-10",
        "last_updated": "2024-12-15",
        "certification_date": "2024-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.