Gregory Russell Hannon, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

59142 Issued in MN

Practice address

3316 W 66TH St Ste 200
Edina, MN 55435-2544

Phone

(952) 303-8600

Fax

(952) 920-8899

NPI assigned

Apr 16, 2013

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Gregory Russell Boone Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Mayo Medical School, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatology Specialists, PAGroup PAC ID 1456248137, 18 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• M Health Fairview Southdale Hospital Hospital, Edina, MN, CCN 240078

Merit-based Incentive Payment System (MIPS)

Final score

79.35 of 100Reported as group

Quality

58.09

Improvement activities

40

Cost

87.03

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Juris Doctor, Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ghannon@directaddress.net

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.

• Dermatology Specialists, PA

  • Dermatology Physician
  • Edina, MN
  • NPI 1992752117
  Medicare reassignment Care Compare group NPD

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

• Fairview Health Services

  dba Fairview Hospital University

  • General Acute Care Hospital
  • Minneapolis, MN
  • NPI 1013994359
  Care Compare affiliation
• Fairview Health Services

  dba Fairview Southdale Hospital

  • General Acute Care Hospital
  • Edina, MN
  • NPI 1699752915
  Care Compare affiliation
• Fairview Health Services

  dba Fairview Diagnostic Laboratory

  • General Acute Care Hospital
  • Edina, MN
  • NPI 1932260833
  Care Compare affiliation

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

{
    "created_epoch": "1366070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1659714913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3316 WEST 66TH ST",
            "address_2": "#200",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55435",
            "telephone_number": "952-920-3808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3316 W 66TH ST STE 200",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352544",
            "telephone_number": "952-303-8600",
            "fax_number": "952-920-8899"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "775 Prairie Center Dr Ste 370",
            "address_purpose": "LOCATION",
            "city": "Eden Prairie",
            "state": "MN",
            "postal_code": "553447330",
            "country_code": "US",
            "telephone_number": "952-920-3808",
            "fax_number": "952-920-8899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANNON",
        "first_name": "GREGORY",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-16",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MN",
            "license": "59142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GREGORY",
            "last_name": "BOONE",
            "middle_name": "RUSSELL",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• India Hampton
• Kyle Robert Hamre, CERTIFIED PROSTHETIS
• Alfred Parkhill Hand, M.D.
• Zachary Handler, MD
• Emily Jean Hanneman, OTD
• Jo Ann Freed Hannon, PSY.D., L.P.
• Alexa Hanowski, PA-STUDENT
• Ernst Hansch, MD
• Bethany Noel Hansen, PT
• Carol E Hansen, CRNA

• Dermatology Physician in Edina, MN
• Providers in Edina, MN by specialty
• Dermatology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.