NPIMap

Individual provider Active NPI

George Thomas O'Bryan, M.D.

  • Nephrology Physician
  • Edina, MN
National Provider Identifier
1417061904
Registry record updated Dec 3, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
36653 Issued in MN
Practice address
6363 France Ave S
Suite 400
Edina, MN 55435-2129
Phone
(952) 920-2070
Fax
(952) 920-7444
NPI assigned
Aug 19, 2006
Last updated
Dec 3, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 36653 MN Primary

Addresses

Primary practice location

6363 France Ave S
Suite 400
Edina, MN 55435-2129

Mailing address

6363 France Ave S
Suite 400
Edina, MN 55435-2129
Phone (952) 920-2070

Other identifiers 7

IdentifierTypeStateIssuer
41Q33OBOtherMNBCBS
HP25085OtherMNHEALTHPARTNERS
3180156OtherMNMEDICA PRIMARY
87401600MedicaidMN
3107053OtherMNPHP
1016006OtherMNPREFERRED ONE
32463400OtherWIWISCONSIN MA

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
I20100128000977 MN Practitioner - Nephrology 1456262252 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of Minnesota Medical School, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Health ServicesGroup PAC ID 1951213057, 677 clinicians
Intermed Consultants Dialysis PLLCGroup PAC ID 7012225105, 11 clinicians
Intermed Consultants,LTD.Group PAC ID 8022033372, 17 clinicians

Practice addresses (Care Compare)

201 E Nicollet Blvd
Burnsville, MN 55337-5714
Phone (952) 892-2000

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

6600 France Ave S
Suite 162
Edina, MN 55435-1802
Phone (952) 920-2070

911 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-1313

919 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-3344

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36653MNMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Express Care CurrentSince Mar 1, 2020 Accepting new patients
Intermed Consultants Dialysis, PLLC Nephrology CurrentSince Sep 15, 2015 Accepting new patients
Fairview Clinics CurrentSince Dec 29, 2020 Accepting new patients
Fairview Health Services CurrentSince Dec 29, 2020 Accepting new patients
Fairview Express Care CurrentSince Mar 1, 2020 Accepting new patients
Intermed Consultants,LTD. Nephrology CurrentSince May 1, 1998 Accepting new patients

Locations

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

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

6363 France Ave S
Ste 400
Minneapolis, MN 55435
Phone (651) 312-1700

6600 France Ave S
Ste 162
Minneapolis, MN 55435
Phone (612) 920-2070

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

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

5354 Edgewood Dr
Saint Paul, MN 55112

Interoperability endpoints

  • Direct secure messaging: george_thomas.o'bryan@direct.davitaphysiciansolutions.com

Organizations & group practices 9

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 10

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

NPI Registry JSON

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196640000000",
    "number": "1417061904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6363 FRANCE AVE S",
            "address_2": "SUITE 400",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352129",
            "telephone_number": "952-920-2070",
            "fax_number": "952-920-7444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6363 FRANCE AVE S",
            "address_2": "SUITE 400",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352129",
            "telephone_number": "952-920-2070",
            "fax_number": "952-920-7444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRYAN",
        "first_name": "GEORGE",
        "middle_name": "THOMAS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2007-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MN",
            "license": "36653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "41Q33OB",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP25085",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA PRIMARY",
            "identifier": "3180156",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "87401600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP",
            "identifier": "3107053",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1016006",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN MA",
            "identifier": "32463400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.