Individual provider Active NPI

Eric Joseph Hazen, M.D.

  • Family Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1386830818
Registry record updated Sep 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
103389 Issued in MN
Practice address
425 20TH Ave S
Minneapolis, MN 55454-4400
Phone
(612) 332-4973
NPI assigned
Sep 18, 2007
Last updated
Sep 18, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 18, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 103389 MN Primary

Addresses

Primary practice location

425 20TH Ave S
Minneapolis, MN 55454-4400

Mailing address

2510 29TH Ave S
Minneapolis, MN 55406-1338
Phone (612) 220-6528

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080402000568 MN Practitioner - Family Practice 7214014117 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
103389MNMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Hennepin Healthcare System, Inc Current Accepting new patients
Hennepin Healthcare System, Inc CurrentSince Mar 3, 2014 Accepting new patients
Hennepin Healthcare System Inc CurrentSince Mar 3, 2014 Accepting new patients

Locations

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

701 Park Ave
#S6
Minneapolis, MN 55415

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190073600000",
    "number": "1386830818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 29TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554061338",
            "telephone_number": "612-220-6528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 20TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554544400",
            "telephone_number": "612-332-4973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAZEN",
        "first_name": "ERIC",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-18",
        "last_updated": "2007-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "103389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.