NPIMap

Individual provider Active NPI

Vidu Bala Mokkala, MD

  • Internal Medicine Physician
  • Fridley, MN
National Provider Identifier
1396918207
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
52840 Issued in MN
Practice address
550 Osborne Rd NE
Fridley, MN 55432-2718
Phone
(763) 236-3518
NPI assigned
Apr 11, 2008
Last updated
Nov 10, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 207R00000X NU
Internal Medicine Physician 207R00000X 52840 MN Primary

Addresses

Primary practice location

550 Osborne Rd NE
Fridley, MN 55432-2718

Mailing address

2925 Chicago Ave
Minneapolis, MN 55407-1321

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vmokkala118937@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20101202001249 MN Practitioner - Internal Medicine 0547457566 Reassigns benefits to 11 organizations
I20190912003168 WI Practitioner - Internal Medicine 0547457566 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Twin Cities Physicians Professional CorporationGroup PAC ID 9830499763, 66 clinicians
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

1415 Lilac Dr N
Suite 190
Golden Valley, MN 55422-4544
Phone (763) 267-8701

1629 E Division St
River Falls, WI 54022-1571
Phone (715) 307-6000

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Park Nicollet Clinic CurrentSince Nov 1, 2016 Accepting new patients
Allina Health System Current Accepting new patients
Saint Elizabeths Hospital of Wabasha Inc CurrentSince May 18, 2016 Accepting new patients
Healtheast Woodwinds Hospital CurrentSince Apr 22, 2016 Accepting new patients
Allina Health System Internal Medicine CurrentSince Jul 27, 2010 Accepting new patients
Healtheast St. John's Hospital CurrentSince Apr 22, 2016 Accepting new patients
Allina Health System Specialist CurrentSince Aug 16, 2019 Accepting new patients
Allina Health System CurrentSince Jan 11, 2023 Accepting new patients
Healtheast Medical Research Institute Internal Medicine CurrentSince Jan 22, 2018 Accepting new patients
Ridgeview Medical Center Current Accepting new patients
Allina Health System Current Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Saint Elizabeths Hospital of Wabasha Inc Current Accepting new patients
Healtheast Medical Research Institute CurrentSince Jan 22, 2018 Accepting new patients
Fairview Health Services CurrentSince Aug 10, 2016 Accepting new patients
Ridgeview Medical Center CurrentSince Oct 1, 2013 Accepting new patients
Minnesota Valley Health Center Inc Current Accepting new patients
Park Nicollet Clinic Current Accepting new patients
Ridgeview Medical Center CurrentSince Oct 1, 2013 Accepting new patients
Fairview Express Care CurrentSince Aug 10, 2016 Accepting new patients
Saint Elizabeths Hospital of Wabasha Inc CurrentSince May 18, 2016 Accepting new patients
Allina Health System CurrentSince Jul 27, 2010 Accepting new patients
Mother of Mercy Past Accepting new patients
Allina Health System Past Accepting new patients
St Francis Regional Medical Center Past Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

701 Dellwood St S
Cambridge, MN 55008
Phone (763) 689-7700

7907 Powers Blvd
Chanhassen, MN 55317
Phone (952) 934-0570

320 E Main St
Crosby, MN 56441
Phone (218) 546-7000

621 S 4th St
Le Sueur, MN 56058
Phone (507) 665-3375

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

550 Osborne Rd NE
Minneapolis, MN 55432
Phone (763) 236-3800

9055 Springbrook Dr NW
Minneapolis, MN 55433
Phone (763) 780-9155

1013 Hart Blvd
Monticello, MN 55362
Phone (763) 271-2303

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

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

69 Exchange St W
Saint Paul, MN 55102
Phone (651) 232-1100

6500 Excelsior Blvd
St Louis Park, MN 55426
Phone (952) 993-3246

1200 Grant Blvd W
Wabasha, MN 55981
Phone (651) 565-4531

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

500 S Maple St
Ofc
Waconia, MN 55387

1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100

1629 E Division St
River Falls, WI 54022
Phone (715) 307-6000

Organizations & group practices 28

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.

View all 28

Hospital & facility affiliations 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1396918207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 OSBORNE RD NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554322718",
            "telephone_number": "763-236-3518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOKKALA",
        "first_name": "VIDU",
        "middle_name": "BALA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-11",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": "207R00000X",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "52840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vmokkala118937@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "550 Osborne Rd NE",
            "city": "Fridley",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554322718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fridley, MN

Sources for this page

Verify at the official NPI Registry.