NPIMap

Individual provider Active NPI

Evan Kendahl Moser-Bleil, M.D.

  • Internal Medicine Physician
  • Eagan, MN
National Provider Identifier
1326307786
Registry record updated Sep 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
58130 Issued in MN
Practice address
3305 Central Park Village Dr
Eagan, MN 55121-7707
Phone
(651) 406-8860
NPI assigned
May 4, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 27, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 58130 MN Primary
Pediatrics Physician 208000000X 58130 MN
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

3305 Central Park Village Dr
Eagan, MN 55121-7707

Mailing address

3305 Central Park Village Dr
Eagan, MN 55121-7707
Phone (651) 406-8860

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
I20160715000299 MN Practitioner - Internal Medicine 9436456357 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rush Medical College of Rush University, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

18580 Joplin Ave
Lakeville, MN 55044-4218
Phone (952) 892-9555

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
24690MNMDFamily Medicine Physician
58130MNMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Clinics CurrentSince Jun 11, 2016 Accepting new patients
Fairview Express Care CurrentSince Jun 11, 2016 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Express Care CurrentSince Jun 11, 2016 Accepting new patients
Fairview Clinics CurrentSince Jun 11, 2016 Accepting new patients
Fairview Clinics CurrentSince Jun 11, 2016 Accepting new patients
Fairview Health Services CurrentSince Jun 11, 2016 Accepting new patients
Fairview Clinics Past Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

3305 Central Park Village Dr
Eagan, MN 55121
Phone (651) 406-8860

3305 Central Park Village Dr
Ste 20
Eagan, MN 55121

18580 Joplin Ave
Lakeville, MN 55044
Phone (952) 892-9500

400 Stinson Blvd
Fl 2
Minneapolis, MN 55413
Phone (612) 672-2203

420 Delaware St SE
#913
Minneapolis, MN 55455
Phone (612) 624-0990

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

3305 Central Park Village Dr
Ste 200
Saint Paul, MN 55121
Phone (651) 406-8860

Interoperability endpoints

  • Direct secure messaging: emoserbleil273339@fairview.direct-ci.com

Organizations & group practices 11

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.

Hospital & facility affiliations 8

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": "1336089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569542400000",
    "number": "1326307786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3305 CENTRAL PARK VILLAGE DR",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551217707",
            "telephone_number": "651-406-8860",
            "fax_number": "651-406-8870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3305 CENTRAL PARK VILLAGE DR",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551217707",
            "telephone_number": "651-406-8860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSER-BLEIL",
        "first_name": "EVAN",
        "middle_name": "KENDAHL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-04",
        "last_updated": "2019-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "58130",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "58130",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

Verify at the official NPI Registry.