NPIMap

Organization Active NPI

Ophthalmology PA

  • Ophthalmology Physician
  • Edina, MN
National Provider Identifier
1114921996
Registry record updated May 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
0026007 Issued in MN
Legal business name
OPHTHALMOLOGY PA
Practice address
3100 W 70TH St
Edina, MN 55435-4227
Phone
(952) 848-8300
Fax
(952) 848-8313
NPI assigned
Jun 9, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2026

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

Authorized official

Name
Jessica Louise Berg
Title
Business Office
Phone
(952) 848-8383

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X 0026007 MN Primary
Eyewear Supplier 332H00000X 0026007 MN

Addresses

Primary practice location

3100 W 70TH St
Edina, MN 55435-4227

Mailing address

3100 W 70TH St
Edina, MN 55435-4227
Phone (952) 848-8300

Other identifiers 5

IdentifierTypeStateIssuer
CP4332OtherMNRAILROAD MEDICARE
130790POtherMNBLUE SHIELD OF MINNESOTA
156OtherMNHEALTH PARTNERS
585010000MedicaidMN
D044OtherMNUCARE MINNESOTA

Other names 1

  • McCannel Eye Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060613000155 MN Part B Supplier - Clinic/Group Practice 9335151307 Receives reassigned benefits from 4 practitioners
Practice locations: Edina, MN
O20100930066509 MN DME Supplier - Physician - OphthalmologyDME Supplier - Optician 9335151307 Practice locations: Edina, MN

Laboratory certificates & supplier records

Derived by NPIMap

These 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

SupplierSuppliesMedicare assignment
McCanel Eye Clinic3100 W 70TH St, Edina, MN 55435-4227(952) 848-8300 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Oct 1, 1984

National Provider Directory

National Provider Directory

Locations

3100 W 70th St
Minneapolis, MN 55435
Phone (952) 848-8300

Interoperability endpoints

  • Direct secure messaging: safiat@ophpa.intellechartdirect.net
  • Direct secure messaging: ssanderson@ophpa.intellechartdirect.net
  • Direct secure messaging: dpatterson@ophpa.intellechartdirect.net
  • Direct secure messaging: amoss@ophpa.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777593600000",
    "number": "1114921996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 W 70TH ST",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354227",
            "telephone_number": "952-848-8300",
            "fax_number": "952-848-8313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 W 70TH ST",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354227",
            "telephone_number": "952-848-8300",
            "fax_number": "952-848-8313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPHTHALMOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-09",
        "last_updated": "2026-05-01",
        "certification_date": "2026-05-01",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "BUSINESS OFFICE",
        "authorized_official_telephone_number": "952-848-8383"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "0026007",
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MN",
            "license": "0026007",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CP4332",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF MINNESOTA",
            "identifier": "130790P",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "156",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "585010000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MINNESOTA",
            "identifier": "D044",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McCannel Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.