Individual provider Active NPI

Meghan Leigh Fanta, MD

  • Pediatrics Physician
  • Cincinnati, OH
National Provider Identifier
1356738546
Registry record updated Jul 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
63320 Issued in MN
Practice address
3333 Burnet Ave
Cincinnati, OH 45229
Phone
(315) 750-8455
NPI assigned
Apr 25, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 5, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 63320 MN Primary

Addresses

Primary practice location

3333 Burnet Ave
Cincinnati, OH 45229

Mailing address

3333 Burnet Ave
Cincinnati, OH 45229-3026
Phone (315) 750-8455

Other practice location 1

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 624-3113

Other practice location 2

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 624-3113

Other practice location 3

2525 Chicago Ave
Minneapolis, MN 55404-4518
Phone (612) 818-6000

Other practice location 4

345 Smith Ave N
Saint Paul, MN 55102-2346
Phone (651) 220-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, OH2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180816000444 MN Practitioner - Pediatric Medicine 0042569527 Reassigns benefits to 2 organizations
I20200826003743 OH Practitioner - Hospitalist 0042569527 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
63320MNMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hennepin Healthcare System, Inc Current Accepting new patients
Hennepin Healthcare System, Inc CurrentSince Sep 24, 2018 Accepting new patients
Fairview Express Care CurrentSince Oct 15, 2018 Accepting new patients
Fairview Health Services CurrentSince Oct 15, 2018 Accepting new patients
Hennepin Healthcare System Inc CurrentSince Sep 24, 2018 Accepting new patients
Children'S Hospital Medical Center Pediatrics CurrentSince Jul 3, 2020 Accepting new patients
Fairview Health Services Current Accepting new patients
Children'S Hospital Medical Center Past Accepting new patients

Locations

3341 Solutions Ctr
Chicago, IL 60677

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

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

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

3333 Burnet Ave
Cincinnati, OH 45229
Phone (513) 636-4200

3333 Burnet Ave
#5021
Cincinnati, OH 45229
Phone (513) 636-4225

Organizations & group practices 9

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": "1429920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562284800000",
    "number": "1356738546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 BURNET AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452293026",
            "telephone_number": "315-750-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 BURNET AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "45229",
            "telephone_number": "315-750-8455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2450 Riverside Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "55454",
            "country_code": "US",
            "telephone_number": "612-624-3113",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2450 Riverside Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "55454",
            "country_code": "US",
            "telephone_number": "612-624-3113",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2525 Chicago Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554044518",
            "country_code": "US",
            "telephone_number": "612-818-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "345 Smith Ave N",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551022346",
            "country_code": "US",
            "telephone_number": "651-220-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FANTA",
        "first_name": "MEGHAN",
        "middle_name": "LEIGH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-25",
        "last_updated": "2019-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "63320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.