Individual provider Active NPI

Darrick W Proehl, D.P.M.

  • Podiatrist
  • Richfield, MN
National Provider Identifier
1629417506
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
1027 Issued in MN
Practice address
6625 Lyndale Ave S Ste 105
Richfield, MN 55423-2673
Phone
(612) 788-8778
Fax
(612) 869-3473
NPI assigned
Jun 24, 2013
Last updated
Aug 31, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X EL1859 MN
Foot & Ankle Surgery Podiatrist 213ES0103X 5140 CA
Podiatrist 213E00000X 1027 MN Primary

Addresses

Primary practice location

6625 Lyndale Ave S Ste 105
Richfield, MN 55423-2673

Mailing address

6625 Lyndale Ave S Ste 300
Richfield, MN 55423-2491
Phone (612) 788-8778

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, MN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150305000426 CA Practitioner - Podiatry 2365768504 Practice locations: Los Gatos, CA
I20191008000107 MN Practitioner - Podiatry 2365768504 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
In House Senior Services LLCGroup PAC ID 7113170267, 16 clinicians

Practice addresses (Care Compare)

6625 Lyndale Ave S
Suite 105
Richfield, MN 55423-2673
Phone (612) 788-8778

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue2697
Removal or shaving of skin growth761

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5140CAMDFoot & Ankle Surgery Podiatrist
EL1859MNMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
In House Senior Services, LLC Podiatrist CurrentSince Sep 1, 2023 Accepting new patients

Locations

6625 Lyndale Ave S
Ste 105
Richfield, MN 55423
Phone (612) 200-8029

6625 Lyndale Ave S
Ste 300
Richfield, MN 55423
Phone (612) 243-8999

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1372032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1629417506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6625 LYNDALE AVE S STE 300",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554232491",
            "telephone_number": "612-788-8778",
            "fax_number": "612-869-3473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6625 LYNDALE AVE S STE 105",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554232673",
            "telephone_number": "612-788-8778",
            "fax_number": "612-869-3473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROEHL",
        "first_name": "DARRICK",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-24",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MN",
            "license": "EL1859",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "5140",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MN",
            "license": "1027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richfield, MN

Sources for this page

Verify at the official NPI Registry.