Individual provider Active NPI

Gaurav Sanjay Suryawanshi, MD

  • Student in an Organized Health Care Education/Training Program
  • Minneapolis, MN
National Provider Identifier
1164042446
Registry record updated May 17, 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 St SE
Minneapolis, MN 55455-0341
Phone
(612) 625-8999
NPI assigned
Apr 16, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 74423 MN
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

420 Delaware St SE
Minneapolis, MN 55455-0341

Mailing address

420 Delaware St SE, MMC 36
Minneapolis, MN 55455
Phone (612) 625-8999

Other practice location 1

2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone (612) 672-6000

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
I20230628002507 MN Practitioner - Internal Medicine 8123445418 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
96.44 of 100Reported as group
Quality
82.65
Promoting interoperability
100
Improvement activities
40
Cost
77.21

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Clinics Current Accepting new patients
Healtheast Medical Research Institute Internal Medicine CurrentSince Jul 1, 2023 Accepting new patients
Fairview Express Care CurrentSince Jul 1, 2023 Accepting new patients
Healtheast Medical Research Institute CurrentSince Jul 1, 2023 Accepting new patients
Fairview Clinics CurrentSince Jul 1, 2023 Accepting new patients
Fairview Health Services CurrentSince Jul 1, 2023 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Health Services CurrentSince Jul 1, 2023 Accepting new patients
Fairview Clinics CurrentSince Jul 1, 2023 Accepting new patients
Fairview Express Care CurrentSince Jul 1, 2023 Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

420 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-6483

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

420 Delaware St SE
#36
Minneapolis, MN 55455
Phone (612) 273-8425

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

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

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100

Interoperability endpoints

  • Direct secure messaging: gsuryawanshi501691@fairview.direct-ci.com

Organizations & group practices 12

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": "1586995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715904000000",
    "number": "1164042446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST SE, MMC 36",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55455",
            "telephone_number": "612-625-8999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550341",
            "telephone_number": "612-625-8999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2450 Riverside Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554541450",
            "country_code": "US",
            "telephone_number": "612-672-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SURYAWANSHI",
        "first_name": "GAURAV",
        "middle_name": "SANJAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-16",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "74423",
            "primary": false
        },
        {
            "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.