Lara Hayel Al-Ejeilat, MD – Pediatrics Physician

Key facts

NPI: 1679889042
Entity type: Individual (NPI type 1)
Primary specialty: Pediatrics Physician 208000000X
License: 56470 (MN)
Practice address: 14500 99TH Ave N
Maple Grove, MN 55369-4730
Phone: (763) 898-1000
Fax: (763) 898-1009
NPI assigned: Aug 24, 2010
Sex: Female
Sole proprietor: No

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 and National Provider Directory roles.

Fairview Clinics Primary Care Clinic/Center · Minneapolis, MN · NPI 1346432218

Medicare reassignment NPD MN
Fairview Health Services Emergency Medicine Physician · Minneapolis, MN · NPI 1811077175

Medicare reassignment MN
Fairview Clinics Primary Care Clinic/Center · Saint Paul, MN · NPI 1396552147

NPD
Fairview Express Care Multi-Specialty Clinic/Center · Eden Prairie, MN · NPI 1710293402

NPD
Fairview Health Services General Acute Care Hospital · Minneapolis, MN · NPI 1013994359

NPD
Fairview Health Services Land Ambulance · Saint Paul, MN · NPI 1710212485

NPD

Medicare participation

Medicare fee-for-service enrollment: Enrolled in MN
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20130815000764	MN	Practitioner - Pediatric Medicine	8628210994	Reassigns benefits to 2 organizations

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
56470	MN	MD	Pediatrics Physician

Practice roles

Organization	Status	New patients
Fairview Clinics	Current	Accepting new patients
Fairview Health Services	Current since Apr 10, 2018	Accepting new patients
Fairview Health Services	Current	Accepting new patients
Fairview Express Care	Current since Apr 10, 2018	Accepting new patients
Fairview Clinics	Current since Apr 10, 2018	Accepting new patients

Locations

13819 Hanson Blvd NW
Andover, MN 55304
Phone (763) 572-5700

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

14500 99th Ave N
Maple Grove, MN 55369
Phone (763) 898-1000

600 W 98th St
Minneapolis, MN 55420
Phone (952) 881-2651

400 Stinson Blvd
Fl 2
Minneapolis, MN 55413
Phone (612) 672-2203

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

Interoperability endpoints

Direct secure messaging: lalejeilat300790@fairview.direct-ci.com

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pediatrics Physician	208000000X	56470	MN	Yes

Addresses

Primary practice location

14500 99TH Ave N
Maple Grove, MN 55369-4730

Mailing address

5103 Lincoln Dr
Edina, MN 55436-1009
Phone (352) 871-1592

Other providers in Maple Grove, MN

All providers in Maple Grove, MN · Pediatrics Physician in Minnesota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2013. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.