NPIMap

Individual provider Active NPI

Amanda Baillargeon, M.D.

  • Diagnostic Radiology Physician
  • Eden Prairie, MN
National Provider Identifier
1386063295
Registry record updated Jul 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
59650 Issued in MN
Practice address
7595 Anagram Dr
Eden Prairie, MN 55344-7399
Phone
(612) 573-2200
Fax
(612) 573-2274
NPI assigned
Apr 8, 2014
Last updated
Jul 12, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 12, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Diagnostic Radiology Physician 2085R0202X 59650 MN Primary

Addresses

Primary practice location

7595 Anagram Dr
Eden Prairie, MN 55344-7399

Mailing address

7595 Anagram Dr
Eden Prairie, MN 55344-7399
Phone (612) 573-2200

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
I20150819007312 MN Practitioner - Diagnostic Radiology 4385959493 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Utah School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Luke's Hospital of DuluthGroup PAC ID 7113834839, 409 clinicians

Practice addresses (Care Compare)

915 E 1St St
Duluth, MN 55805-2107
Phone (218) 249-5439

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
59650MNMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke's Hospital of Duluth CurrentSince Feb 1, 2023 Accepting new patients
Noran Neurological Clinic P.a. CurrentSince Jul 1, 2020 Accepting new patients
St. Luke's Hospital of Duluth CurrentSince Feb 1, 2023 Accepting new patients
St. Luke's Hospital of Duluth Current Accepting new patients
Consulting Radiologists, LTD Diagnostic Radiology PastSince Jul 1, 2020 Accepting new patients
Quest Diagnostics LLC Il PastSince Jul 1, 2020 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860

915 E 1st St
Duluth, MN 55805
Phone (218) 249-5352

2828 Chicago Ave
Ste 200
Minneapolis, MN 55407
Phone 61287910001502

3601 Minnesota Dr
Ste 200
Minneapolis, MN 55435
Phone (952) 992-5691

500 S Maple St
Waconia, MN 55387
Phone (612) 442-2191

Organizations & group practices 6

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.

Hospital & facility affiliations 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1396915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657584000000",
    "number": "1386063295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7595 ANAGRAM DR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553447399",
            "telephone_number": "612-573-2200",
            "fax_number": "612-573-2274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7595 ANAGRAM DR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553447399",
            "telephone_number": "612-573-2200",
            "fax_number": "612-573-2274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAILLARGEON",
        "first_name": "AMANDA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-08",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "59650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eden Prairie, MN

Sources for this page

Verify at the official NPI Registry.