Active NPI
Dirck Anthony Rilla, CCP
- Perfusionist
- Minneapolis, MN
National Provider Identifier
1720410293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Perfusionist
- License
- 214-000199
- Practice address
- 2545 Chicago Ave
Suite 417
Minneapolis, MN 55404-4522 - Phone
- (612) 977-2030
- Fax
- (612) 977-2017
- NPI assigned
- Aug 6, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Perfusionist | 242T00000X | 214-000199 | IL | Primary |
Addresses
Primary practice location
2545 Chicago Ave
Suite 417
Minneapolis, MN 55404-4522
Mailing address
2545 Chicago Ave
Suite 417
Minneapolis, MN 55404-4522
Phone (612) 977-2030
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 214-000199 | IL | MD | Perfusionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375747200000",
"number": "1720410293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2545 CHICAGO AVE",
"address_2": "SUITE 417",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554044522",
"telephone_number": "612-977-2030",
"fax_number": "612-977-2017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2545 CHICAGO AVE",
"address_2": "SUITE 417",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554044522",
"telephone_number": "612-977-2030",
"fax_number": "612-977-2017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RILLA",
"first_name": "DIRCK",
"middle_name": "ANTHONY",
"credential": "CCP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-06",
"last_updated": "2013-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "242T00000X",
"taxonomy_group": "",
"desc": "Perfusionist",
"state": "IL",
"license": "214-000199",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.