NPIMap

Individual provider Active NPI

William R. Omlie, M.D.

  • Vascular Surgery Physician
  • Edina, MN
National Provider Identifier
1518997782
Registry record updated Apr 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
27471 Issued in MN
Practice address
6405 France Ave S
Suite W440
Edina, MN 55435-2163
Phone
(952) 927-7004
Fax
(952) 927-5146
NPI assigned
Jul 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 27471 MN
Vascular Surgery Physician 2086S0129X 27471 MN Primary

Addresses

Primary practice location

6405 France Ave S
Suite W440
Edina, MN 55435-2163

Mailing address

3400 W 66TH St
Suite 350
Edina, MN 55435-2111
Phone (952) 832-0805

Other identifiers 1

IdentifierTypeStateIssuer
663788400MedicaidMN

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
I20050608000077 MN Practitioner - Vascular Surgery 3173518362 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
University of Minnesota Medical School, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians
Fairview Specialty ServicesGroup PAC ID 3072083286, 303 clinicians

Practice addresses (Care Compare)

1700 University Ave W
Saint Paul, MN 55104-3727
Phone (855) 324-7843

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

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

6405 France Ave S
Suite W440
Edina, MN 55435-2190
Phone (952) 927-7004

6525 France Ave S
Suite 275
Edina, MN 55435-2107
Phone (952) 831-8346

717 Delaware St SE
Suite 340
Minneapolis, MN 55414-2959
Phone (612) 672-7422

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.63 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
75.75

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal1-10
Melanoma (skin cancer) excision1-10
Leg revascularization (restoring blood flow)14
Removal of tissue142
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
27471MNMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care CurrentSince Oct 1, 2020 Accepting new patients
Fairview Health Services CurrentSince Oct 1, 2008 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Health Services CurrentSince Oct 1, 2008 Accepting new patients
Fairview Express Care CurrentSince Oct 1, 2020 Accepting new patients
Fairview Express Care Current Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Healtheast Medical Research Institute Surgery CurrentSince Sep 8, 2018 Accepting new patients
Fairview Health Services Past Accepting new patients
Surgical Consultants, P.a. Surgery Past Accepting new patients

Locations

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

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

303 E Nicollet Blvd
Ste 300
Burnsville, MN 55337
Phone (952) 435-4140

6405 France Ave S
Ste 440
Edina, MN 55435
Phone (952) 927-7004

6405 France Ave S
Ste W440
Edina, MN 55435
Phone (952) 345-4178

6525 France Ave S
Ste 275
Edina, MN 55435
Phone (952) 831-8346

6363 France Ave S
Ste 550
Minneapolis, MN 55435
Phone (612) 927-7004

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

6401 France Ave S
Minneapolis, MN 55435
Phone (952) 920-8477

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

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

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

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

Interoperability endpoints

  • Direct secure messaging: womlie147706@fairview.direct-ci.com

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366329600000",
    "number": "1518997782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 W 66TH ST",
            "address_2": "SUITE 350",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352111",
            "telephone_number": "952-832-0805",
            "fax_number": "952-832-5597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6405 FRANCE AVE S",
            "address_2": "SUITE W440",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352163",
            "telephone_number": "952-927-7004",
            "fax_number": "952-927-5146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMLIE",
        "first_name": "WILLIAM",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2013-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MN",
            "license": "27471",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MN",
            "license": "27471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "663788400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.