NPIMap

Individual provider Active NPI

Risa Bache-Wiig, MD

  • Family Medicine Physician
  • Crystal, MN
National Provider Identifier
1417453366
Registry record updated Nov 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
65974 Issued in MN
Practice address
5109 36TH Ave N
Crystal, MN 55422-2007
Phone
(763) 587-7900
Fax
(763) 587-7989
NPI assigned
Mar 31, 2018
Last updated
Nov 7, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 65974 MN Primary
General Practice Physician 208D00000X 65974 MN

Addresses

Primary practice location

5109 36TH Ave N
Crystal, MN 55422-2007

Mailing address

9201 W Broadway Ave Ste 601
Brooklyn Park, MN 55445-1924
Phone (763) 587-7900

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address risabachewiig@nor.eclinicaldirectplus.com

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
I20190814004032 MN Practitioner - Family Practice 1456608892 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Clinic PAGroup PAC ID 2769384205, 50 clinicians

Practice addresses (Care Compare)

5109 36TH Ave N
Crystal, MN 55422-2007
Phone (763) 587-7900

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
65974MNMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care Current Accepting new patients
North Clinic, PA Family Medicine CurrentSince Feb 1, 2020 Accepting new patients
North Clinic, PA Family Medicine CurrentSince Feb 1, 2020 Accepting new patients
Fairview Express Care CurrentSince Jul 11, 2019 Accepting new patients
Fairview Express Care General Practice CurrentSince Jul 11, 2019 Accepting new patients

Locations

9825 Hospital Dr
Ste 300
Maple Grove, MN 55369
Phone (763) 494-7500

5109 36th Ave N
Minneapolis, MN 55422
Phone (630) 632-2648

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

9201 W Broadway Ave
Ste 601
Minneapolis, MN 55445
Phone (763) 587-7933

50 Central Ave
Osseo, MN 55369
Phone (612) 588-4625

1414 Maryland Ave E
Saint Paul, MN 55106
Phone (651) 772-3461

Interoperability endpoints

  • Direct secure messaging: risa.bachewiig@nor.eclinicaldirectplus.com

Organizations & group practices 5

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 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1522454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1417453366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9201 W BROADWAY AVE STE 601",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554451924",
            "telephone_number": "763-587-7900",
            "fax_number": "763-587-7066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5109 36TH AVE N",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554222007",
            "telephone_number": "763-587-7900",
            "fax_number": "763-587-7989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACHE-WIIG",
        "first_name": "RISA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-31",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "65974",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MN",
            "license": "65974",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "risabachewiig@nor.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "9825 Hospital Dr Ste 300",
            "city": "Maple Grove",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553694768",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Crystal, MN

Sources for this page

Verify at the official NPI Registry.