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Individual provider Active NPI

Ricky Yuk Kiu Chan, PA-C

  • Physician Assistant
  • Minneapolis, MN
National Provider Identifier
1639134307
Registry record updated Jun 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9989 Issued in MN
Practice address
420 Delaware St SE
Ctr for BLD and Clot Disorders, Suite B-549, MMC 713
Minneapolis, MN 55455-0341
Phone
(612) 626-6455
Fax
(612) 625-4955
NPI assigned
Apr 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 11, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9989 MN Primary

Addresses

Primary practice location

420 Delaware St SE
Ctr for BLD and Clot Disorders, Suite B-549, MMC 713
Minneapolis, MN 55455-0341

Mailing address

420 Delaware St SE
Ctr for BLD and Clot Disorders, Suite B-549, MMC 713
Minneapolis, MN 55455-0341
Phone (612) 626-6455

Other identifiers 1

IdentifierTypeStateIssuer
206936900MedicaidMN

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
I20050802000111 MN Practitioner - Physician Assistant 8426086315 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

717 Delaware St SE
Suite 340
Minneapolis, MN 55414-2959
Phone (612) 672-7422

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.63 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Express Care CurrentSince Oct 21, 2024 Accepting new patients
Fairview Health Services CurrentSince Oct 20, 2008 Accepting new patients
Fairview Health Services CurrentSince Oct 20, 2008 Accepting new patients
Fairview Express Care CurrentSince Oct 21, 2024 Accepting new patients
Fairview Health Services Past Accepting new patients

Locations

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

2512 S 7th St
Ste 105
Minneapolis, MN 55454
Phone (612) 273-5005

420 Delaware St SE
Bldg And
Minneapolis, MN 55455
Phone (612) 626-6455

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

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

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

2512 S 7th St
Fl 1
Minneapolis, MN 55454
Phone (612) 273-9400

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

Interoperability endpoints

  • Direct secure messaging: rchan41986@fairview.direct-ci.com

Organizations & group practices 6

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.

Hospital & facility affiliations 7

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": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244678400000",
    "number": "1639134307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST SE",
            "address_2": "CTR FOR BLD AND CLOT DISORDERS, SUITE B-549, MMC 713",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550341",
            "telephone_number": "612-626-6455",
            "fax_number": "612-625-4955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 DELAWARE ST SE",
            "address_2": "CTR FOR BLD AND CLOT DISORDERS, SUITE B-549, MMC 713",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554550341",
            "telephone_number": "612-626-6455",
            "fax_number": "612-625-4955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "RICKY",
        "middle_name": "YUK KIU",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2009-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "9989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "206936900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.