Individual provider Active NPI

Samuel Calvert Dudley Jr., M.D., PH.D

  • Cardiovascular Disease Physician
  • Minneapolis, MN
National Provider Identifier
1568575173
Registry record updated Nov 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD14147 Issued in RI
Practice address
2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone
(612) 672-6000
NPI assigned
Aug 16, 2006
Last updated
Nov 1, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 336.080316 IL
Cardiovascular Disease Physician 207RC0000X 044910 GA
Cardiovascular Disease Physician 207RC0000X MD14147 RI Primary

Addresses

Primary practice location

2450 Riverside Ave
Minneapolis, MN 55454-1450

Mailing address

420 Delaware Street SE
Minneapolis, MN 55455
Phone (612) 624-8970

Other identifiers 1

IdentifierTypeStateIssuer
MD14147OtherRIPROFESSIONAL LICENSE

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170510001046 MN Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 3274602420 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Virginia Commonwealth University, School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

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

500 Harvard St SE
Minneapolis, MN 55455-0363
Phone (612) 672-7422

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

909 Fulton St SE
Minneapolis, MN 55455-4800
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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
044910GAMDCardiovascular Disease Physician
336.080316ILMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Express Care Current Accepting new patients
Healtheast Medical Research Institute CurrentSince Mar 16, 2020 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Apr 8, 2017 Accepting new patients
Fairview Clinics CurrentSince Apr 8, 2017 Accepting new patients
Healtheast Medical Research Institute Cardiovascular Disease CurrentSince Mar 16, 2020 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Express Care Cardiovascular Disease CurrentSince Apr 8, 2017 Accepting new patients
Fairview Health Services CurrentSince Apr 8, 2017 Accepting new patients
Fairview Express Care CurrentSince Jan 1, 2019 Accepting new patients
Cardiothoracic Surgery Clinic of North Ms Past 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

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

420 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-6483

516 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-3600

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

909 Fulton St SE
Ste 318
Minneapolis, MN 55455

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

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

2900 Curve Crest Blvd W
Stillwater, MN 55082
Phone (651) 471-5600

Interoperability endpoints

  • Direct secure messaging: sdudley406818@fairview.direct-ci.com

Organizations & group practices 13

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 13

Hospital & facility affiliations 3

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": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509494400000",
    "number": "1568575173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 DELAWARE STREET SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55455",
            "telephone_number": "612-624-8970",
            "fax_number": "612-626-4411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-672-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDLEY",
        "first_name": "SAMUEL",
        "middle_name": "CALVERT",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D., PH.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2017-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "336.080316",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "GA",
            "license": "044910",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "RI",
            "license": "MD14147",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL LICENSE",
            "identifier": "MD14147",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.