Michael John Ebertz, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

36998 Issued in MN

Practice address

14000 Nicollet Ave
Suite 304
Burnsville, MN 55337-5790

Phone

(952) 898-1600

NPI assigned

Dec 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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

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.

• Skin Care Doctors, P.a.

  • Medical Specialty Clinic/Center
  • Burnsville, MN
  • NPI 1851516397
  Medicare reassignment NPD Authorized official
• Reese Surgical Group PLLC

  • Vascular Surgery Physician
  • Edina, MN
  • NPI 1972762631
  NPD (past)

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1144386392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14000 NICOLLET AVE STE 304",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553375784",
            "telephone_number": "952-898-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14000 NICOLLET AVE",
            "address_2": "SUITE 304",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553375790",
            "telephone_number": "952-898-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERTZ",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MN",
            "license": "36998",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MN",
            "license": "36998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "225522700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick Brian Ebeling, M.D.
• Ebenezer Ridges
• Ebenezer Ridges Adult Day Center
• Ebenezer Ridges Assisted Living
• Ebenezer Society, LLC
• Zakiya Ebrahim
• Brooke Michelle Echter
• Dillon Eddy
• Edina Eye Physicians and Surgeons PA
• Jennifer Kay Edlund, L.P.C.C.

• Dermatology Physician in Burnsville, MN
• Providers in Burnsville, MN by specialty
• Dermatology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; 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.