Liza Antoinette Jain Phu, M.D.
Individual provider Active NPI Family Medicine Physician · Jordan, MN
NPI 1174758908 · NPPES record last updated Nov 10, 2020
Key facts
- NPI
- 1174758908
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 53359 (MN)
- Practice address
- 265 Creek LN S
Jordan, MN 55352-1214 - Phone
- (952) 428-1200
- Fax
- (952) 428-1201
- NPI assigned
- May 22, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Minnesota Medical School, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Francis Regional Medical Center
Allina Health System
Practice addresses (Care Compare)
1601 Saint Francis Ave
Suite 200
Shakopee, MN 55379-3385
Phone (952) 428-4133
265 Creek LN S
Jordan, MN 55352-1214
Phone (952) 428-1200
440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225
Hospital & facility affiliations
- Allina Health Home Health
- St Francis Regional Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141215001665 | MN | Practitioner - Family Practice | 4880888296 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036.129032 | IL | MD | Family Medicine Physician |
| 53359 | MN | MD | Family Medicine Physician |
| 60116222 | WA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allina Health System | Current |
Accepting new patients | |
| Allina Health System | Family Medicine | Current | Accepting new patients |
| St Francis Regional Medical Center | Current |
Accepting new patients | |
| Allina Health System | Family Medicine | Current |
Accepting new patients |
| St. Francis Regional Medical Center | Current |
Accepting new patients | |
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Current |
Accepting new patients | |
| Allina Health System | Family Medicine | Past | Accepting new patients |
| St Francis Regional Medical Center | Past | Accepting new patients |
Locations
440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225
265 Creek Ln S
Jordan, MN 55352
Phone (952) 428-1200
2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800
2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813
7373 France Ave S
Ste 202
Minneapolis, MN 55435
Phone (952) 835-1311
2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640
4201 Dean Lakes Blvd
Ste 120
Shakopee, MN 55379
Phone (952) 496-6700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 60116222 | WA | |
| Family Medicine Physician | 207Q00000X | 036.129032 | IL | |
| Family Medicine Physician | 207Q00000X | 53359 | MN | Yes |
Addresses
Primary practice location
265 Creek LN S
Jordan, MN 55352-1214
Mailing address
2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-5000
Other names
- Liza Antoinette Garcia Jain
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | lphu267037@excellian.direct.allina.com | Direct |
Other providers in Jordan, MN
- Diana Olsen
- April Orr
- Penney Family Chiropractic, LLC
- Hollie Penney
- Scott Charles Penney
- Amanda Preiner
- Kiirsten Rakers
- Alicia Ray
- Ruby Sky Therapy and Wellness
- Karis Rygg
All providers in Jordan, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.