NPIMap

Individual provider Active NPI

Vijay Neelamegam Premnath, M.D

  • Geriatric Medicine (Family Medicine) Physician
  • Tioga, ND
National Provider Identifier
1285834614
Registry record updated Apr 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
11852 Issued in ND
Practice address
810 N Welo St
Tioga, ND 58852
Phone
(701) 664-3305
Fax
(701) 664-3300
NPI assigned
Jul 24, 2007
Last updated
Apr 4, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X 11852 ND Primary

Addresses

Primary practice location

810 N Welo St
Tioga, ND 58852

Mailing address

810 N Welo St
Tioga, ND 58852
Phone (701) 664-3305

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vneelamegampremnath6654165@direct.sanfordhealth.org

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
I20150717000698 MN Practitioner - Family PracticePractitioner - Geriatric Medicine 0648443283 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians
Optage IncGroup PAC ID 2264619345, 61 clinicians

Practice addresses (Care Compare)

15350 English Ave
Apple Valley, MN 55124-6252
Phone (952) 431-8500

2500 Como Ave
Saint Paul, MN 55108-1460
Phone (651) 641-0020

2945 Lincoln Dr
Roseville, MN 55113-1338
Phone (651) 631-6570

8325 Seasons Pkwy
Woodbury, MN 55125-4402
Phone (651) 702-5868

8450 Seasons Pkwy
Woodbury, MN 55125-4402
Phone (651) 702-5300

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11852NDMDGeriatric Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. CurrentSince Jul 10, 2023 Accepting new patients
Group Health, Inc. Current Accepting new patients
Group Health, Inc. CurrentSince Jul 10, 2023 Accepting new patients

Locations

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

Organizations & group practices 4

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 9

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

NPI Registry JSON

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

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649030400000",
    "number": "1285834614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 N WELO ST",
            "city": "TIOGA",
            "state": "ND",
            "postal_code": "58852",
            "telephone_number": "701-664-3305",
            "fax_number": "701-664-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 N WELO ST",
            "city": "TIOGA",
            "state": "ND",
            "postal_code": "58852",
            "telephone_number": "701-664-3305",
            "fax_number": "701-664-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEELAMEGAM PREMNATH",
        "first_name": "VIJAY",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-24",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "ND",
            "license": "11852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vneelamegampremnath6654165@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "810 N Welo St",
            "city": "Tioga",
            "state": "ND",
            "country_code": "US",
            "postal_code": "58852",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tioga, ND

Sources for this page

Verify at the official NPI Registry.