Active NPI
Ilan Vavilin, MD
- Internal Medicine Physician
- Minneapolis, MN
National Provider Identifier
1578022315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 81522
- Practice address
- 420 Delaware St SE
Minneapolis, MN 55455-0341 - Phone
- (612) 625-5454
- NPI assigned
- Mar 19, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 0101270941 | VA | |
| Internal Medicine Physician | 207R00000X | 81522 | MN | Primary |
| Internal Medicine Physician | 207R00000X | MD210002590 | DC |
Addresses
Primary practice location
420 Delaware St SE
Minneapolis, MN 55455-0341
Mailing address
420 Delaware St SE Dept M
Minneapolis, MN 55455-0386
Phone (612) 625-5454
Other practice location 1
3300 Gallows Rd
Falls Church, VA 22042-3307
Phone (703) 776-3582
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD210002590 | DC | MD | Internal Medicine Physician |
| 81522 | MN | MD | Internal Medicine Physician |
| 0101270941 | VA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medstar Medical Group II LLC | Current | Accepting new patients |
Locations
1145 19th St NW
Ste 311
Washington, DC 20036
Phone (202) 429-2401
3800 Reservoir Rd NW
Washington, DC 20007
Phone (202) 687-2203
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774396800000",
"number": "1578022315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 DELAWARE ST SE DEPT M",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550386",
"telephone_number": "612-625-5454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 DELAWARE ST SE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550341",
"telephone_number": "612-625-5454"
}
],
"practiceLocations": [
{
"address_1": "3300 Gallows Rd",
"address_purpose": "LOCATION",
"city": "Falls Church",
"state": "VA",
"postal_code": "220423307",
"country_code": "US",
"telephone_number": "703-776-3582",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VAVILIN",
"first_name": "ILAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-03-19",
"last_updated": "2026-03-25",
"certification_date": "2026-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "VA",
"license": "0101270941",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MN",
"license": "81522",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "DC",
"license": "MD210002590",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.