NPIMap

Individual provider Active NPI

Deanna Phan, CNP

  • Adult Health Nurse Practitioner
  • Edina, MN
National Provider Identifier
1215620430
Registry record updated Jun 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
10144 Issued in MN
Practice address
3400 W 66TH St Ste 150
Edina, MN 55435-2109
Phone
(952) 920-7200
NPI assigned
Jun 1, 2023
Last updated
Jun 1, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 10144 MN Primary
Gerontology Nurse Practitioner 363LG0600X 10144 MN

Addresses

Primary practice location

3400 W 66TH St Ste 150
Edina, MN 55435-2109

Mailing address

21381 Hytrail Cir
Lakeville, MN 55044-6035
Phone (952) 239-4568

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230713002352 MN Practitioner - Nurse Practitioner 0345600011 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Minneapolis Clinic of Neurology LTDGroup PAC ID 5496668659, 75 clinicians

Practice addresses (Care Compare)

3400 W 66TH St
Suite 150
Edina, MN 55435-2109
Phone (952) 920-7200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.39 of 100Reported as group
Quality
84.12
Promoting interoperability
100
Improvement activities
40
Cost
83.94

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Master of Science

State licenses

LicenseStateTypeSpecialty
10144MNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Minneapolis Clinic of Neurology, LTD CurrentSince Jul 10, 2023 Accepting new patients
Laboratory Corportation of America Holdings PastSince Jun 4, 2023 Accepting new patients

Locations

3400 W 66th St
Ste 150
Minneapolis, MN 55435
Phone (952) 920-7200

4225 Golden Valley Rd
Minneapolis, MN 55422
Phone (612) 588-0661

Interoperability endpoints

  • Direct secure messaging: dphan196969@direct.northmemorial.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 26

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1685577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685577600000",
    "number": "1215620430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21381 HYTRAIL CIR",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550446035",
            "telephone_number": "952-239-4568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 W 66TH ST STE 150",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352109",
            "telephone_number": "952-920-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "DEANNA",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-01",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "10144",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MN",
            "license": "10144",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.