Lisa R. Irvin, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

41186 Issued in MN

Practice address

3910 Excelsior Blvd
St Louis Park, MN 55416-4709

Phone

(952) 562-8787

Fax

(952) 562-8788

NPI assigned

Mar 3, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Children'S Clinic Network

  • Primary Care Clinic/Center
  • Hugo, MN
  • NPI 1447529235
  Medicare reassignment NPD
• Children'S Clinic Network

  • Primary Care Clinic/Center
  • Brooklyn Park, MN
  • NPI 1588522668
  NPD
• Metropolitan Pediatric Specialists, P.a.

  • Clinic/Center
  • Edina, MN
  • NPI 1558459206
  NPD (past)

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

{
    "created_epoch": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316649600000",
    "number": "1124095575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3910 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554164709",
            "telephone_number": "952-562-8787",
            "fax_number": "952-562-8788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3910 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554164709",
            "telephone_number": "952-562-8787",
            "fax_number": "952-562-8788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRVIN",
        "first_name": "LISA",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-03",
        "last_updated": "2011-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "41186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "294718800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Integration Psychotherapy and Welln
• Integration Psychotherapy and Wellness PLLC
• Intrepid USA
• Introspective Psychotherapies
• Grace Marie Irish, APNP
• Elizabeth Ann Isakson
• Taryn Teresa Ishaug, PHARM D.
• Sarah Islam, MD
• Kelsey Widmyer Israelson, PA
• Farhia Issa

• Pediatrics Physician in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; 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.

Verify at the official NPI Registry.