NPIMap

Individual provider Active NPI

Edward Rainier Gamboa Santos, MD

  • Orthopaedic Surgery Physician
  • Plymouth, MN
National Provider Identifier
1659474773
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
47367 Issued in MN
Practice address
15700 37TH Ave N Ste 150
Plymouth, MN 55446-3675
Phone
(651) 968-5201
Fax
(651) 968-5904
NPI assigned
Sep 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 47367 MN Primary

Addresses

Primary practice location

15700 37TH Ave N Ste 150
Plymouth, MN 55446-3675

Mailing address

710 Commerce Dr Ste 200
Woodbury, MN 55125-4925
Phone (651) 968-5201

Other practice location 1

301 Highway 65 S
Mora, MN 55051-1899
Phone (320) 679-1212

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address egamboasantos322732@excellian.direct.allina.com Direct

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
I20051007000731 MN Practitioner - Orthopedic Surgery 1254356389 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Orthopedics, LTDGroup PAC ID 8921900374, 282 clinicians

Practice addresses (Care Compare)

15700 37TH Ave N
Suite 150
Plymouth, MN 55446-3675
Phone (651) 968-5201

Hospital & facility affiliations

  • M Health Fairview Southdale Hospital Hospital, Edina, MN, CCN 240078
  • Abbott Northwestern Hospital Hospital, Minneapolis, MN, CCN 240057
  • Welia Health Hospital, Mora, MN, CCN 241367
  • Maple Grove Hospital Hospital, Maple Grove, MN, CCN 240214

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion103
Laminectomy or laminotomy (partial removal of spine bones)65

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
47367MNMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Clinics CurrentSince Sep 10, 2009 Accepting new patients
Fairview Health Services Current Accepting new patients
Welia Health CurrentSince Mar 29, 2022 Accepting new patients
Summit Orthopedics LTD Current Accepting new patients
Summit Orthopedics LTD Orthopaedic Surgery CurrentSince Apr 1, 2016 Accepting new patients
Summit Orthopedics, LTD. CurrentSince Apr 1, 2016 Accepting new patients
Fairview Health Services CurrentSince Sep 10, 2009 Accepting new patients
Summit Orthopedics, LTD Orthopaedic Surgery Current Accepting new patients
Ilbnc, P.a. Past Accepting new patients

Locations

10230 Baltimore St NE
#300
Blaine, MN 55449
Phone (651) 968-5300

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

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

420 Delaware St SE
#126
Minneapolis, MN 55455
Phone (612) 626-2378

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

301 Highway 65 S
Mora, MN 55051
Phone (320) 225-3317

15700 37th Ave N
Ste 150
Plymouth, MN 55446
Phone (651) 968-1627

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

4000 Central Ave NE
Saint Anthony, MN 55421
Phone (763) 572-5700

1661 Saint Anthony Ave
Saint Paul, MN 55104
Phone (651) 968-5300

2620 Eagan Woods Dr
Saint Paul, MN 55121
Phone (651) 968-5142

3580 Arcade St
Vadnais Heights, MN 55127
Phone (651) 968-5600

710 Commerce Dr
Ste 200
Woodbury, MN 55125
Phone (651) 968-5042

2090 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 968-5801

Interoperability endpoints

  • Direct secure messaging: egamboasantos322732@excellian.direct.allina.com
  • Direct secure messaging: egamboasantos440115@direct.centracare.com
  • Direct secure messaging: edwardrainiersantos@sol.allscriptsdirect.net

Organizations & group practices 11

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 29

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1659474773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 COMMERCE DR STE 200",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254925",
            "telephone_number": "651-968-5201",
            "fax_number": "651-968-5904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15700 37TH AVE N STE 150",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463675",
            "telephone_number": "651-968-5201",
            "fax_number": "651-968-5904"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 Highway 65 S",
            "address_purpose": "LOCATION",
            "city": "Mora",
            "state": "MN",
            "postal_code": "550511899",
            "country_code": "US",
            "telephone_number": "320-679-1212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANTOS",
        "first_name": "EDWARD RAINIER",
        "middle_name": "GAMBOA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MN",
            "license": "47367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "egamboasantos322732@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "301 Highway 65 S",
            "city": "Mora",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550511899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

Verify at the official NPI Registry.