Active NPI
Russell Eide, PA-C
- Physician Assistant
- Minneapolis, MN
National Provider Identifier
1366096729
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1164184
- Practice address
- 3300 Oakdale Ave N
Minneapolis, MN 55422-2926 - Phone
- (763) 520-5200
- NPI assigned
- Jul 24, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1164184 | Primary |
Addresses
Primary practice location
3300 Oakdale Ave N
Minneapolis, MN 55422-2926
Mailing address
2986 S Superior St
Milwaukee, WI 53207-2544
Phone (715) 308-4563
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone (763) 581-0907
Hospital & facility affiliations
- Home Health Care Inc
- North Memorial Health Hospital
- Abbott Northwestern Hospital
- Maple Grove Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Memorial Health Care | Current | Accepting new patients | |
| North Memorial Health Care | Current | Accepting new patients |
Locations
9875 Hospital Dr
Maple Grove, MN 55369
Phone (763) 581-1000
8100 42nd Ave N
New Hope, MN 55427
Phone (763) 581-5700
3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048
Interoperability endpoints
- reide208784@direct.northmemorial.com
Organizations & group practices 3
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.
-
- General Acute Care Hospital
- Robbinsdale, MN
- NPI 1851344907
-
- General Acute Care Hospital
- Robbinsdale, MN
- NPI 1568893220
-
- Clinic/Center
- Blaine, MN
- NPI 1841995552
Hospital & facility affiliations 29
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Obesity Medicine (Family Medicine) Physician
- Minneapolis, MN
- NPI 1154684835
Hospital
-
- Physical Medicine & Rehabilitation Physician
- Minneapolis, MN
- NPI 1275577215
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563926400000",
"number": "1366096729",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2986 S SUPERIOR ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532072544",
"telephone_number": "715-308-4563"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3300 OAKDALE AVE N",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554222926",
"telephone_number": "763-520-5200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EIDE",
"first_name": "RUSSELL",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-24",
"last_updated": "2019-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": "1164184",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.