NPIMap

Individual provider Active NPI

Jill Suzanne Melicher Larson, MD

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Bloomington, MN
National Provider Identifier
1285788950
Registry record updated Oct 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmic Plastic and Reconstructive Surgery PhysicianTaxonomy code 207WX0200X
License
53626 Issued in MN
Practice address
9801 Dupont Ave S
200
Bloomington, MN 55431-3100
Phone
(952) 888-5800
NPI assigned
Jan 22, 2007
Last updated
Oct 17, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2017

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 105147 MN
Ophthalmic Plastic and Reconstructive Surgery Physician 207WX0200X 53626 MN Primary

Addresses

Primary practice location

9801 Dupont Ave S
200
Bloomington, MN 55431-3100

Mailing address

9801 Dupont Ave S
Suite 425
Bloomington, MN 55431-3100
Phone (952) 888-5800

Other names 1

  • Jill Suzanne Melicher Other name

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
I20100928001713 MN Practitioner - Ophthalmology 4587736103 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
University of North Dakota School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hennepin Healthcare System IncGroup PAC ID 4789684861, 905 clinicians
Minnesota Eye Consultants, PAGroup PAC ID 4284524539, 34 clinicians

Practice addresses (Care Compare)

701 Park Ave
Minneapolis, MN 55415-1623
Phone (612) 873-6963

9801 Dupont Ave S
Suite 200
Bloomington, MN 55431-3200
Phone (952) 888-5800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.11 of 100Reported as group
Quality
73.53
Promoting interoperability
100
Improvement activities
40
Cost
60.18

Merit-based Incentive Payment System (MIPS)

Final score
92.67 of 100Reported as group
Quality
74.5
Promoting interoperability
100
Improvement activities
40
Cost
72.86

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53626MNMDOphthalmic Plastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hennepin Healthcare System, Inc Current Accepting new patients
Hennepin Healthcare System, Inc CurrentSince Jan 4, 2012 Accepting new patients
Minnesota Eye Consultants, PA Ophthalmology CurrentSince Sep 1, 2010 Accepting new patients
Hennepin Healthcare System Inc CurrentSince Jan 4, 2012 Accepting new patients
Northwest Eye Clinic, LLC Ophthalmology Past Accepting new patients
Minnesota Eye Consultants, PA Ophthalmology Past Accepting new patients

Locations

11091 Ulysses St NE
Ste 300
Blaine, MN 55434
Phone (763) 421-9410

701 Park Ave
Minneapolis, MN 55415
Phone (612) 873-6005

914 S 8th St
#D4
Minneapolis, MN 55404
Phone (612) 347-6450

914 S 8th St
Ste D4
Minneapolis, MN 55404
Phone (612) 347-3744

9801 DuPont Ave S
Ste 200
Minneapolis, MN 55431

9801 DuPont Ave S
Ste 425
Minneapolis, MN 55431
Phone (952) 567-6092

12501 Whitewater Dr
Ste 310
Minnetonka, MN 55343

7125 Tamarack Rd
Ste 100
Woodbury, MN 55125

Organizations & group practices 6

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 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508198400000",
    "number": "1285788950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9801 DUPONT AVE S",
            "address_2": "SUITE 425",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554313100",
            "telephone_number": "952-888-5800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9801 DUPONT AVE S",
            "address_2": "200",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554313100",
            "telephone_number": "952-888-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELICHER LARSON",
        "first_name": "JILL",
        "middle_name": "SUZANNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2017-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "105147",
            "primary": false
        },
        {
            "code": "207WX0200X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": "MN",
            "license": "53626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILL",
            "last_name": "MELICHER",
            "middle_name": "SUZANNE",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bloomington, MN

Sources for this page

Verify at the official NPI Registry.