Individual provider Active NPI

Liz Allyson Crandall, M.D.

  • Obstetrics & Gynecology Physician
  • Edina, MN
National Provider Identifier
1740394469
Registry record updated Sep 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
35627 Issued in MN
Practice address
3625 W 65TH St
Suite 100
Edina, MN 55435-2106
Phone
(952) 920-7001
Fax
(952) 920-2245
NPI assigned
Aug 19, 2006
Last updated
Sep 20, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 35627 MN Primary

Addresses

Primary practice location

3625 W 65TH St
Suite 100
Edina, MN 55435-2106

Mailing address

3625 W 65TH St
Suite 100
Edina, MN 55435-2106
Phone (952) 920-7001

Other identifiers 3

IdentifierTypeStateIssuer
1M507CROtherMNBCBS
0725457OtherMNMEDICA
994508300MedicaidMN

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100621000822 MN Practitioner - Obstetrics/Gynecology 5496654923 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.24 of 100Reported as group
Quality
86.35
Promoting interoperability
100
Improvement activities
40
Cost
71.1

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35627MNMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier OBGYN of Minnesota PLLC Obstetrics & Gynecology CurrentSince Apr 1, 2011 Accepting new patients

Locations

305 E Nicollet Blvd
Ste 393
Burnsville, MN 55337
Phone (952) 435-9505

3625 W 65th St
Ste 100
Minneapolis, MN 55435
Phone (952) 920-7001

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316476800000",
    "number": "1740394469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3625 W 65TH ST",
            "address_2": "SUITE 100",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352106",
            "telephone_number": "952-920-7001",
            "fax_number": "952-920-2245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3625 W 65TH ST",
            "address_2": "SUITE 100",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352106",
            "telephone_number": "952-920-7001",
            "fax_number": "952-920-2245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRANDALL",
        "first_name": "LIZ",
        "middle_name": "ALLYSON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-19",
        "last_updated": "2011-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "35627",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1M507CR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "0725457",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "994508300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.