NPIMap

Individual provider Active NPI

Leigh Koidahl, M.D.

  • Obstetrics & Gynecology Physician
  • Edina, MN
National Provider Identifier
1740422815
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
56355 Issued in MN
Practice address
3625 W 65TH St Ste 100
Edina, MN 55435-2147
Phone
(952) 345-7070
Fax
(952) 345-0472
NPI assigned
Apr 3, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Obstetrics & Gynecology Physician 207V00000X 56355 MN Primary

Addresses

Primary practice location

3625 W 65TH St Ste 100
Edina, MN 55435-2147

Mailing address

3625 W 65TH St Ste 100
Edina, MN 55435-2147
Phone (952) 345-7070

Other practice location 1

305 E Nicollet Blvd Ste 393
Burnsville, MN 55337-8328
Phone (952) 435-9505

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
I20130724000961 MN Practitioner - Obstetrics/Gynecology 9739320375 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Minnesota Medical School, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Premier OBGYN of Minnesota PLLCGroup PAC ID 1355396110, 88 clinicians

Practice addresses (Care Compare)

3625 W 65TH St
Suite 100
Edina, MN 55435-2147
Phone (952) 920-7001

Hospital & facility affiliations

  • M Health Fairview University of MN Medical Center Hospital, Minneapolis, MN, CCN 240080
  • M Health Fairview Southdale Hospital Hospital, Edina, MN, CCN 240078
  • M Health Fairview Ridges Hospital Hospital, Burnsville, MN, CCN 240207

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
56355MNMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier OBGYN of Minnesota PLLC Obstetrics & Gynecology CurrentSince Aug 1, 2013 Accepting new patients
Fairview Health Services Past 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

Interoperability endpoints

  • Direct secure messaging: leigh.koidahl.1@20897.direct.athenahealth.com

Organizations & group practices 2

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 7

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

NPI Registry JSON

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

{
    "created_epoch": "1238716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1740422815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3625 W 65TH ST STE 100",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352147",
            "telephone_number": "952-345-7070",
            "fax_number": "952-345-0472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3625 W 65TH ST STE 100",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352147",
            "telephone_number": "952-345-7070",
            "fax_number": "952-345-0472"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "305 E Nicollet Blvd Ste 393",
            "address_purpose": "LOCATION",
            "city": "Burnsville",
            "state": "MN",
            "postal_code": "553378328",
            "country_code": "US",
            "telephone_number": "952-435-9505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOIDAHL",
        "first_name": "LEIGH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-03",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "56355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.