NPIMap

Individual provider Active NPI

Raluca F Banica-Wolters, MD

  • Neurology Physician
  • Edina, MN
National Provider Identifier
1699741058
Registry record updated May 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
39464 Issued in MN
Practice address
3400 W 66TH St Ste 150
Edina, MN 55435-2109
Phone
(952) 920-7200
Fax
(763) 302-4234
NPI assigned
Feb 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 39464 MN Primary

Addresses

Primary practice location

3400 W 66TH St Ste 150
Edina, MN 55435-2109

Mailing address

3400 W 66TH St Ste 150
Edina, MN 55435-2109
Phone (952) 920-7200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rbanicawolters167925@direct.northmemorial.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
I20101218000055 MN Practitioner - Neurology 6901094879 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Minneapolis Clinic of Neurology LTDGroup PAC ID 5496668659, 75 clinicians

Practice addresses (Care Compare)

3400 W 66TH St
Suite 150
Edina, MN 55435-2109
Phone (952) 920-7200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39464MNMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Glencoe Regional Health Services CurrentSince May 25, 2019 Accepting new patients
Glencoe Regional Health Services CurrentSince May 25, 2019 Accepting new patients
Minneapolis Clinic of Neurology, LTD Neurology CurrentSince Aug 20, 2018 Accepting new patients
Laboratory Corportation of America Holdings PastSince Aug 20, 2018 Accepting new patients

Locations

1805 Hennepin Ave N
Glencoe, MN 55336
Phone (320) 864-3121

3400 W 66th St
Ste 150
Minneapolis, MN 55435
Phone (952) 920-7200

4225 Golden Valley Rd
Minneapolis, MN 55422
Phone (612) 588-0661

Interoperability endpoints

  • Direct secure messaging: rbanicawolters167925@direct.northmemorial.com
  • Direct secure messaging: rbanica165923@excellian.direct.allina.com

Organizations & group practices 4

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 41

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

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652745600000",
    "number": "1699741058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 W 66TH ST STE 150",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352109",
            "telephone_number": "952-920-7200",
            "fax_number": "763-302-4234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 W 66TH ST STE 150",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352109",
            "telephone_number": "952-920-7200",
            "fax_number": "763-302-4234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANICA-WOLTERS",
        "first_name": "RALUCA",
        "middle_name": "F",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-27",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MN",
            "license": "39464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rbanicawolters167925@direct.northmemorial.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "3400 W 66th St Ste 150",
            "city": "Edina",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554352109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.