Active NPI
Eduardo Tavora Fernandes, M.D.
- Urology Physician
- Minneapolis, MN
National Provider Identifier
1639108830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 36795
- Practice address
- University of Minnesota Physicians
516 Delaware Street SE, PWB First Floor, Clinic 1E
Minneapolis, MN 55455 - Phone
- (612) 626-6666
- NPI assigned
- Jul 1, 2006
- Last updated
- Jul 9, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 36795 | MN | Primary |
Addresses
Primary practice location
University of Minnesota Physicians
516 Delaware Street SE, PWB First Floor, Clinic 1E
Minneapolis, MN 55455
Mailing address
University of Minnesota Physicians
420 Delaware Street SE, MMC 394
Minneapolis, MN 55455
Phone (612) 626-6666
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 122707 | Other | MN | UCARE |
| 1016618 | Other | MN | PREFERRED ONE |
| 19-00018 | Other | MN | MEDICA PRIMARY |
| 383R1FE | Other | MN | BCBS |
| 0596908 | Medicaid | IA | |
| 19-00526 | Other | MN | MEDICA CHOICE |
| 777876 | Other | MN | ARAZ |
| HP26223 | Other | MN | HEALTHPARTNERS |
| 0147459 | Medicaid | MT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Columbia Park Medical Group, PA | Urology | Past | Accepting new patients |
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, 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": "1151712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1639108830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "UNIVERSITY OF MINNESOTA PHYSICIANS",
"address_2": "420 DELAWARE STREET SE, MMC 394",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55455",
"telephone_number": "612-626-6666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "UNIVERSITY OF MINNESOTA PHYSICIANS",
"address_2": "516 DELAWARE STREET SE, PWB FIRST FLOOR, CLINIC 1E",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55455",
"telephone_number": "612-626-6666"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERNANDES",
"first_name": "EDUARDO",
"middle_name": "TAVORA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-01",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "MN",
"license": "36795",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "122707",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1016618",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA PRIMARY",
"identifier": "19-00018",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "383R1FE",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0596908",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA CHOICE",
"identifier": "19-00526",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARAZ",
"identifier": "777876",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP26223",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0147459",
"state": "MT"
}
],
"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 Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.