Individual provider Active NPI

Kejela Haji

  • Primary Care Nurse Practitioner
  • Edina, MN
National Provider Identifier
1407430473
Registry record updated Aug 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
8163 Issued in MN
Practice address
7505 Metro Blvd
Edina, MN 55439-3081
Phone
(952) 914-1720
Fax
(952) 914-1727
NPI assigned
May 6, 2021
Last updated
Aug 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 8163 MN Primary

Addresses

Primary practice location

7505 Metro Blvd
Edina, MN 55439-3081

Mailing address

656 Glenbrook Ave N
Oakdale, MN 55128-6507

Other practice location 1

1575 Beam Ave
Maplewood, MN 55109-1126
Phone (652) 232-7000

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL SOAP Health Information Exchange (HIE)

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210927003284 MN Practitioner - Nurse Practitioner 8820495260 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8163MNMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Clinics CurrentSince Aug 1, 2021 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Express Care CurrentSince Aug 1, 2021 Accepting new patients
Fairview Clinics CurrentSince Aug 1, 2021 Accepting new patients
Fairview Health Services CurrentSince Aug 1, 2021 Accepting new patients
Fairview Express Care CurrentSince Aug 1, 2021 Accepting new patients
Fairview Express Care CurrentSince Aug 1, 2021 Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

7505 Metro Blvd
Minneapolis, MN 55439
Phone (651) 271-1665

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

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

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

Organizations & group practices 10

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": "1620259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629072000000",
    "number": "1407430473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "656 GLENBROOK AVE N",
            "city": "OAKDALE",
            "state": "MN",
            "postal_code": "551286507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7505 METRO BLVD",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554393081",
            "telephone_number": "952-914-1720",
            "fax_number": "952-914-1727"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1575 Beam Ave",
            "address_purpose": "LOCATION",
            "city": "Maplewood",
            "state": "MN",
            "postal_code": "551091126",
            "country_code": "US",
            "telephone_number": "652-232-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAJI",
        "first_name": "KEJELA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-06",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MN",
            "license": "8163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "SOAP",
            "affiliation": "N",
            "endpointDescription": "SOAP",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "656 Glenbrook Ave N",
            "city": "Oakdale",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551286507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.