NPIMap

Individual provider Active NPI

Loren Max Wilkes, MD

  • Family Medicine Physician
  • Lino Lakes, MN
National Provider Identifier
1619929395
Registry record updated Jun 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34994 Issued in MN
Practice address
7455 Village Dr
Lino Lakes, MN 55014-1181
Phone
(651) 717-3400
NPI assigned
May 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 34994 MN Primary

Addresses

Primary practice location

7455 Village Dr
Lino Lakes, MN 55014-1181

Mailing address

5200 Fairview Blvd
Wyoming, MN 55092-8013
Phone (651) 717-3400

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
I20060330000585 MN Practitioner - Family Practice 2860400918 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

2849 Johnson St NE
Minneapolis, MN 55418-3055
Phone (612) 672-1900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34994MNMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Health Services CurrentSince May 3, 1999 Accepting new patients
Fairview Clinics CurrentSince May 3, 1999 Accepting new patients
Fairview Express Care CurrentSince Oct 5, 2020 Accepting new patients
Fairview Clinics CurrentSince Oct 5, 2020 Accepting new patients
Fairview Express Care CurrentSince Oct 5, 2020 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Clinics CurrentSince Oct 5, 2020 Accepting new patients
Fairview Express Care Past Accepting new patients
Fairview Clinics Past Accepting new patients

Locations

13819 Hanson Blvd NW
Andover, MN 55304
Phone (763) 572-5700

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

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

7455 Village Dr
Lino Lakes, MN 55014
Phone (651) 389-0189

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

10961 Club West Pkwy
Minneapolis, MN 55449
Phone (763) 572-5700

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

400 Stinson Blvd
#2
Minneapolis, MN 55413
Phone (612) 672-2294

2535 University Ave SE
Minneapolis, MN 55414
Phone (612) 672-2350

2849 Johnson St NE
Minneapolis, MN 55418
Phone (612) 672-1900

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

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

Interoperability endpoints

  • Direct secure messaging: lwilkes3648@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 5

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": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213574400000",
    "number": "1619929395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 FAIRVIEW BLVD",
            "city": "WYOMING",
            "state": "MN",
            "postal_code": "550928013",
            "telephone_number": "651-717-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7455 VILLAGE DR",
            "city": "LINO LAKES",
            "state": "MN",
            "postal_code": "550141181",
            "telephone_number": "651-717-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKES",
        "first_name": "LOREN",
        "middle_name": "MAX",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2008-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "34994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lino Lakes, MN

Sources for this page

Verify at the official NPI Registry.