NPIMap

Individual provider Active NPI

Lana Jane Dirksen, MD

  • Family Medicine Physician
  • Montevideo, MN
National Provider Identifier
1316381965
Registry record updated Jun 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
58748 Issued in MN
Practice address
824 N 11TH St
Montevideo, MN 56265-1629
Phone
(320) 269-6435
NPI assigned
Apr 25, 2013
Last updated
Jun 28, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 28, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 58748 MN Primary

Addresses

Primary practice location

824 N 11TH St
Montevideo, MN 56265-1629

Mailing address

824 N 11TH St
Montevideo, MN 56265-1629
Phone (320) 269-6435

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
I20150616002506 MN Practitioner - Family Practice 9436460565 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2013
Medicare assignment
May accept Medicare assignment
Group practices
Centracare Clinic Southwest LLCGroup PAC ID 8426457946, 172 clinicians
CCM HealthGroup PAC ID 4284539453, 69 clinicians

Practice addresses (Care Compare)

101 Willmar Ave SW
Willmar, MN 56201-3556
Phone (320) 231-5000

824 N 11TH St
Montevideo, MN 56265-1629
Phone (320) 269-8877

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Carris Health LLC CurrentSince Oct 1, 2024 Accepting new patients
Centracare Clinic Southwest LLC CurrentSince Sep 1, 2022 Accepting new patients
CCM Health CurrentSince Aug 1, 2025 Accepting new patients
Carris Health LLC CurrentSince Oct 1, 2024 Accepting new patients
CCM Health CurrentSince May 1, 2015 Accepting new patients
North Memorial Health Care CurrentSince Jun 1, 2020 Accepting new patients
Group Health, Inc. Current Accepting new patients
CCM Health CurrentSince May 1, 2015 Accepting new patients
North Memorial Health Care CurrentSince Jun 1, 2020 Accepting new patients
North Memorial Health Care Current Accepting new patients
Centracare Clinic Southwest LLC CurrentSince Sep 1, 2022 Accepting new patients
Group Health, Inc. CurrentSince Aug 1, 2015 Accepting new patients
Minnesota Pathologists Chartered Current Accepting new patients
Luther Haven Past Accepting new patients
Carris Health LLC Past Accepting new patients
CCM Health Past Accepting new patients
CCM Health Past Accepting new patients

Locations

9875 Hospital Dr
Maple Grove, MN 55369
Phone (763) 581-1000

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

824 N 11th St
Montevideo, MN 56265
Phone (320) 269-8877

600 Peterson Pkwy
New London, MN 56273
Phone (320) 354-2222

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

2251 Connecticut Ave S
Sartell, MN 56377
Phone (320) 253-5220

101 Willmar Ave SW
Willmar, MN 56201
Phone (320) 231-5079

301 Becker Ave SW
Willmar, MN 56201
Phone (320) 231-4120

Interoperability endpoints

  • Direct secure messaging: ldirksen107893@direct.centracare.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
CCM HealthMontevideo, MN, CCN 24Z325 Hospital Corporate Officer (16%) Oct 1, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • CCM Health

    dba Chippewa County Montevideo Hospital Swing Bed

    • Medicare Defined Swing Bed Hospital Unit
    • Montevideo, MN
    • NPI 1346460755

    Corporate Officer

    CMS ownership

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1366848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467072000000",
    "number": "1316381965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 N 11TH ST",
            "city": "MONTEVIDEO",
            "state": "MN",
            "postal_code": "562651629",
            "telephone_number": "320-269-6435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 N 11TH ST",
            "city": "MONTEVIDEO",
            "state": "MN",
            "postal_code": "562651629",
            "telephone_number": "320-269-6435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIRKSEN",
        "first_name": "LANA",
        "middle_name": "JANE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-25",
        "last_updated": "2016-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "58748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montevideo, MN

Sources for this page

Verify at the official NPI Registry.