Active NPI
Charles B Donovan, MD
- Diagnostic Radiology Physician
- Edina, MN
National Provider Identifier
1124077912
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 48603
- Practice address
- 7505 Metro Blvd Ste 400
Edina, MN 55439 - Phone
- (612) 573-2200
- Fax
- (612) 573-2274
- NPI assigned
- May 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 48603 | MN | Primary |
Addresses
Primary practice location
7505 Metro Blvd Ste 400
Edina, MN 55439
Mailing address
7505 Metro Blvd Ste 400
Edina, MN 55439-3010
Phone (612) 573-2200
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2443230 | Other | MN | AMERICA'S PPO |
| 505P3DO | Other | MN | BLUE CROSS BLUE SHIELD |
| HP63008 | Other | MN | HEALTHPARTNERS |
| 99112184 | Other | WI | WI HEALTH INSURANCE RISK SHARING PLAN |
| 0721050 | Medicaid | IA | |
| 16-04146 | Other | MN | MEDICA |
| 252817 | Other | MN | MIDLANDS CHOICE INC |
| 1046956 | Other | MN | PREFERRED ONE |
| 9103415 | Other | MN | PHCS/MULTIPLAN |
| P00327700 | Other | MN | RAILROAD MEDICARE MN |
| 133042 | Other | MN | UCARE |
| P00327697 | Other | WI | RAILROAD MEDICARE WI |
| 34864100 | Medicaid | WI | |
| 621966700 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48603 | MN | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Consulting Radiologists, LTD | Diagnostic Radiology | Past | Accepting new patients |
| Quest Diagnostics LLC Il | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Diagnostic Radiology Physician
- Edina, MN
- NPI 1659339216
-
- Clinical Medical Laboratory
- Chicago, IL
- NPI 1669298055
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530144000000",
"number": "1124077912",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7505 METRO BLVD STE 400",
"city": "EDINA",
"state": "MN",
"postal_code": "554393010",
"telephone_number": "612-573-2200",
"fax_number": "612-573-2274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7505 METRO BLVD STE 400",
"city": "EDINA",
"state": "MN",
"postal_code": "55439",
"telephone_number": "612-573-2200",
"fax_number": "612-573-2274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONOVAN",
"first_name": "CHARLES",
"middle_name": "B",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-09",
"last_updated": "2018-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MN",
"license": "48603",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICA'S PPO",
"identifier": "2443230",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "505P3DO",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP63008",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WI HEALTH INSURANCE RISK SHARING PLAN",
"identifier": "99112184",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0721050",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "16-04146",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MIDLANDS CHOICE INC",
"identifier": "252817",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1046956",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHCS/MULTIPLAN",
"identifier": "9103415",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE MN",
"identifier": "P00327700",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "133042",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE WI",
"identifier": "P00327697",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "34864100",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "621966700",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}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 Jun 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.