Individual provider Active NPI

Prabha Nanjundamurthy Dakshayini

  • Pediatrics Physician
  • Elk River, MN
National Provider Identifier
1265842199
Registry record updated Jul 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
58643 Issued in MN
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

Updated by the provider on Jul 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150227000427 MN Practitioner - Pediatric Medicine 9931425428 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health Plan, Inc. CurrentSince Aug 1, 2023 Accepting new patients
Group Health, Inc. Current Accepting new patients
Sanford Health of Northern Minnesota Current Accepting new patients
Sanford Health of Northern Minnesota CurrentSince Dec 15, 2014 Accepting new patients
MCHS Hospitals Inc Current Accepting new patients
Group Health, Inc. CurrentSince Aug 1, 2023 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

  • Direct secure messaging: pnanjundamurthydakshayini315064@direct.healthpartners.com
  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.