NPIMap

Individual provider Active NPI

Dara D Koozekanani, M.D., PH.D.

  • Ophthalmology Physician
  • Minneapolis, MN
National Provider Identifier
1265497556
Registry record updated Jun 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
50244 Issued in WI
Practice address
420 Delaware St SE
MMC 493
Minneapolis, MN 55455-0341
Phone
(612) 625-9600
Fax
(612) 625-3693
NPI assigned
Apr 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 51736 MN
Ophthalmology Physician 207W00000X 50244 WI Primary

Addresses

Primary practice location

420 Delaware St SE
MMC 493
Minneapolis, MN 55455-0341

Mailing address

1314 Marquette Ave
Apt 1907
Minneapolis, MN 55403-4111
Phone (612) 605-2437

Other practice location 1

3900 Park Nicollet Blvd
St Louis Park, MN 55416-2505
Phone (952) 993-3150

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
I20090914000533 MN Practitioner - Ophthalmology 6305945783 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Ohio State University College of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone (952) 993-3123

3850 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone (952) 993-3123

500 Harvard St SE
Minneapolis, MN 55455-0363
Phone (612) 672-7422

516 Delaware St SE
Minneapolis, MN 55455-0356
Phone (612) 625-4400

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

909 Fulton St SE
Minneapolis, MN 55455-4800
Phone (612) 672-7422

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
51736MNMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Current Accepting new patients
University of Minnesota Physicians Current Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Express Care CurrentSince Jan 1, 2019 Accepting new patients
University of Minnesota Health Clinics and Surgery Center, Inc. CurrentSince Feb 22, 2016 Accepting new patients
Park Nicollet Clinic CurrentSince Aug 1, 2012 Accepting new patients
Fairview Express Care CurrentSince Jan 1, 2019 Accepting new patients
Park Nicollet Clinic CurrentSince Aug 1, 2012 Accepting new patients
Fairview Health Services CurrentSince Nov 9, 2019 Accepting new patients
University of Minnesota Physicians CurrentSince Aug 31, 2009 Accepting new patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince Feb 22, 2016 Accepting new patients
Fairview Health Services Current Accepting new patients

Locations

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

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

420 Delaware St SE
#493
Minneapolis, MN 55455
Phone (612) 625-4400

420 Delaware St SE
#126
Minneapolis, MN 55455
Phone (612) 626-2378

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

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

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

516 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-3600

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

3900 Park Nicollet Blvd
St Louis Park, MN 55416
Phone (952) 993-3017

Interoperability endpoints

  • Direct secure messaging: dkoozekanani147920@fairview.direct-ci.com

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1265497556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1314 MARQUETTE AVE",
            "address_2": "APT 1907",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554034111",
            "telephone_number": "612-605-2437",
            "fax_number": "612-234-4664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST SE",
            "address_2": "MMC 493",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550341",
            "telephone_number": "612-625-9600",
            "fax_number": "612-625-3693"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3900 Park Nicollet Blvd",
            "address_purpose": "LOCATION",
            "city": "St Louis Park",
            "state": "MN",
            "postal_code": "554162505",
            "country_code": "US",
            "telephone_number": "952-993-3150",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOOZEKANANI",
        "first_name": "DARA",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-19",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "51736",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "WI",
            "license": "50244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.