Active NPI
Evan Keith Wotipka
- Ophthalmology Physician
- Minneapolis, MN
National Provider Identifier
1376238352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 000000000
- Practice address
- 701 Park Ave
Minneapolis, MN 55415-1623 - Phone
- (612) 873-3000
- NPI assigned
- Apr 6, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 000000000 | MN | Primary |
Addresses
Primary practice location
701 Park Ave
Minneapolis, MN 55415-1623
Mailing address
701 Park Ave
Minneapolis, MN 55415-1623
Phone (612) 873-3000
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230622000858 | MN | Order and Referring Only - Ophthalmology | 9133587249 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000000000 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1680739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680739200000",
"number": "1376238352",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 PARK AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554151623",
"telephone_number": "612-873-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 PARK AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554151623",
"telephone_number": "612-873-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOTIPKA",
"first_name": "EVAN",
"middle_name": "KEITH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-04-06",
"last_updated": "2023-04-06",
"certification_date": "2023-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MN",
"license": "000000000",
"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 Apr 6, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.