NPIMap

Individual provider Active NPI

Marek Kostanecki, M.D.

  • Internal Medicine Physician
  • Wyoming, MN
National Provider Identifier
1568577492
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD425277 Issued in PA
Practice address
5200 Fairview Blvd
Wyoming, MN 55092-8013
Phone
(651) 982-7000
Fax
(651) 982-7110
NPI assigned
Aug 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD425277 PA Primary

Addresses

Primary practice location

5200 Fairview Blvd
Wyoming, MN 55092-8013

Mailing address

914 Penn Valley Rd
Media, PA 19063-1652
Phone (610) 891-0545

Other practice location 1

1 Medical Center Blvd
acp-336
Chester, PA 19013-3902
Phone (610) 619-8590

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
I20071010000388 MN Practitioner - Internal Medicine 5698672665 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
96.44 of 100Reported as group
Quality
82.65
Promoting interoperability
100
Improvement activities
40
Cost
77.21

Merit-based Incentive Payment System (MIPS)

Final score
87.39 of 100Reported as group
Quality
91.62
Promoting interoperability
100
Improvement activities
40
Cost
66.36

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD425277PAMDInternal Medicine Physician
0008521NYMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Clinics CurrentSince Oct 1, 2021 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Health Services CurrentSince Oct 1, 2021 Accepting new patients
Fairview Express Care CurrentSince Oct 1, 2021 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Perham Hospital District Current Accepting new patients
Perham Hospital District Current Accepting new patients
Fairview Express Care Current Accepting new patients
Healtheast Medical Research Institute Internal Medicine CurrentSince May 17, 2022 Accepting new patients
Healtheast Medical Research Institute CurrentSince May 17, 2022 Accepting new patients
Perham Hospital District CurrentSince Sep 23, 2024 Accepting new patients
Fairview Express Care CurrentSince Oct 1, 2021 Accepting new patients
Perham Hospital District Internal Medicine CurrentSince Sep 23, 2024 Accepting new patients

Locations

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

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

1000 Coney St W
Perham, MN 56573
Phone (218) 347-1200

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

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

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100

5200 Fairview Blvd
Wyoming, MN 55092
Phone (651) 464-4611

Organizations & group practices 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1568577492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 PENN VALLEY RD",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190631652",
            "telephone_number": "610-891-0545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 FAIRVIEW BLVD",
            "city": "WYOMING",
            "state": "MN",
            "postal_code": "550928013",
            "telephone_number": "651-982-7000",
            "fax_number": "651-982-7110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Center Blvd",
            "address_2": "acp-336",
            "address_purpose": "LOCATION",
            "city": "Chester",
            "state": "PA",
            "postal_code": "190133902",
            "country_code": "US",
            "telephone_number": "610-619-8590",
            "fax_number": "610-619-8591",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOSTANECKI",
        "first_name": "MAREK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD425277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MN

Sources for this page

Verify at the official NPI Registry.