NPIMap

Organization Active NPI

Fairview Health Services

Doing business as Fairview Diagnostic Laboratory

  • General Acute Care Hospital
  • Burnsville, MN
National Provider Identifier
1225199128
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
FAIRVIEW HEALTH SERVICES
Doing business as
Fairview Diagnostic Laboratory
Practice address
201 E Nicollet Blvd
Outreach Lab Department
Burnsville, MN 55337-5714
Phone
(952) 892-2085
NPI assigned
Dec 13, 2006
Last updated
Feb 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

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

Authorized official

Name
Maureen V Ring
Title
Sys Dir Govt Reimb & Netwk Rel
Phone
(612) 672-6740

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

201 E Nicollet Blvd
Outreach Lab Department
Burnsville, MN 55337-5714

Mailing address

1700 University Ave W
Saint Paul, MN 55104-3727
Phone (612) 672-6740

Other identifiers 8

IdentifierTypeStateIssuer
4D295FAOtherMNBCBS
1045HPAOtherMNBCBS
5003723OtherMNMEDICA
209550500MedicaidMN
1913201OtherMNMHP
27581OtherMNHEALTHPARTNERS
1006058OtherMNPREFERREDONE
300067OtherMNUCARE

Other names 1

  • Fairview Diagnostic Laboratory Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031105000461 MN Part B Supplier - Clinic/Group Practice 1951213057 Receives reassigned benefits from 4,101 practitioners
This NPI is an additional NPI on the enrollment
O20060126001010 MN Part A Provider - Hospital 1951213057 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Eagan, MN; Burnsville, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225199128. Details of each certification follow.

Hospital certification: CCN 240207

Legal name
FAIRVIEW HEALTH SERVICES
Doing business as
FAIRVIEW RIDGES HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
May 2, 1984
Last certification
Nov 8, 2002
Beds
150
Ownership / control type
Church
Organization structure
CorporationNon-profit
Incorporated
Dec 20, 1972 in MN
Enrollment address
201 E Nicollet Blvd
Burnsville, MN 55337-5714
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
M Health Fairview Ridges HospitalCCN 240207 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Fairview Health Service70 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 22

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 22

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Melissa Ann Geller Individual Corporate DirectorDirector Jan 1, 2022
David Martin Levy Individual Corporate DirectorDirector Jan 1, 2022
Maureen Veronica-Reger Ring Individual Corporate DirectorDirector Ao Dec 1, 2022
W-2 Managing EmployeeDirector Ao Dec 1, 2022
Stephen Jeffrey Swensen Individual Corporate DirectorDirector Jan 1, 2022
Srijoy Mahapatra Individual Corporate DirectorBoard of Director Oct 1, 2024
Jodi Richard Individual Corporate DirectorDirector Jan 1, 2019
Shawntera Monique Hardy Individual Corporate DirectorDirector Jan 1, 2022
Joe Charles Gaylord Individual Corporate DirectorBoard of Director Sep 1, 2022
Kenneth Joseph Roering Individual Corporate DirectorDirector Feb 23, 2017
James Hereford Individual Corporate DirectorPresident Dec 10, 2016
Paul Jr Hill Individual Corporate DirectorDirector Jan 1, 2022
Tami Lynn Reller Individual Corporate DirectorBoard of Director May 9, 2024
Michael Roger Connly Individual Corporate DirectorDirector Jun 1, 2017
Karen Swearingen Richard Individual Corporate DirectorBoard of Director Jan 1, 2025
John Charles Heinmiller Individual Corporate DirectorDirector Jul 1, 2017
Julie S Causey Individual Corporate DirectorDirector Jun 1, 2017
Barclay Edward Berdan Individual Corporate DirectorDirector Jan 1, 2022
Timothy Engel Marx Individual Corporate DirectorDirector Jun 1, 2017

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 892

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 892

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739923200000",
    "number": "1225199128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 UNIVERSITY AVE W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043727",
            "telephone_number": "612-672-6740",
            "fax_number": "612-884-3592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E NICOLLET BLVD",
            "address_2": "OUTREACH LAB DEPARTMENT",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553375714",
            "telephone_number": "952-892-2085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRVIEW HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A",
        "authorized_official_last_name": "RING",
        "authorized_official_first_name": "MAUREEN",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "SYS DIR GOVT REIMB & NETWK REL",
        "authorized_official_telephone_number": "612-672-6740"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4D295FA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1045HPA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "5003723",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209550500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHP",
            "identifier": "1913201",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "27581",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERREDONE",
            "identifier": "1006058",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "300067",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairview Diagnostic Laboratory",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fairview Diagnostic Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Burnsville, MN

Sources for this page

Verify at the official NPI Registry.