Active NPI
Prabha Nanjundamurthy Dakshayini
- Pediatrics Physician
- Elk River, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 58643
- Practice address
- 530 3Rd St NW
Elk River, MN 55330-1445 - Phone
- (763) 587-4800
- NPI assigned
- Apr 30, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | 58643 | MN | Primary |
Addresses
Primary practice location
530 3Rd St NW
Elk River, MN 55330-1445
Mailing address
1 Brookdale PLZ
Brooklyn, NY 11212-3139
Other practice location 1
1611 Anne St NW
Bemidji, MN 56601-5114
Phone (218) 333-5000
Other practice location 2
1 Brookdale Plz
Brooklyn, NY 11212-3139
Phone (718) 240-5000
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Group Health Plan, Inc. | Current | Accepting new patients | |
| Group Health, Inc. | Current | Accepting new patients | |
| Sanford Health of Northern Minnesota | Current | Accepting new patients | |
| Sanford Health of Northern Minnesota | Current | Accepting new patients | |
| MCHS Hospitals Inc | Current | Accepting new patients | |
| Group Health, Inc. | Current | Accepting new patients | |
| Allina Health System | Past | Accepting new patients |
Locations
1611 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2020
530 3rd St NW
Elk River, MN 55330
Phone (763) 587-4800
8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600
4000 28th Ave S
Moorhead, MN 56560
Phone (701) 234-3200
2116 Craig Rd
Eau Claire, WI 54701
Phone (715) 858-4500
3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200
1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111
Interoperability endpoints
- pnanjundamurthydakshayini315064@direct.healthpartners.com
- pm.dakshayini@marshfieldclinichealthsystem.cernerdirect.com
Organizations & group practices 7
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.
-
dba HealthPartners Medical Group
- Multi-Specialty Clinic/Center
- Minneapolis, MN
- NPI 1710924683
-
dba Sanford Health Kelliher Clinic
- Family Medicine Physician
- Kelliher, MN
- NPI 1770849697
-
dba HealthPartners Well@Work-Anoka County
- Health Service Clinic/Center
- Anoka, MN
- NPI 1962704346
-
dba HealthPartners Midway Residency Dental
- General Practice Dentistry
- Saint Paul, MN
- NPI 1952042053
-
dba Joe Lueken Cancer Center
- Internal Medicine Physician
- Bemidji, MN
- NPI 1780628149
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690416000000",
"number": "1265842199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 BROOKDALE PLZ",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112123139"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 3RD ST NW",
"city": "ELK RIVER",
"state": "MN",
"postal_code": "553301445",
"telephone_number": "763-587-4800"
}
],
"practiceLocations": [
{
"address_1": "1611 Anne St NW",
"address_purpose": "LOCATION",
"city": "Bemidji",
"state": "MN",
"postal_code": "566015114",
"country_code": "US",
"telephone_number": "218-333-5000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1 Brookdale Plz",
"address_purpose": "LOCATION",
"city": "Brooklyn",
"state": "NY",
"postal_code": "112123139",
"country_code": "US",
"telephone_number": "718-240-5000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NANJUNDAMURTHY DAKSHAYINI",
"first_name": "PRABHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-30",
"last_updated": "2023-07-27",
"certification_date": "2023-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "58643",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Elk River, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.