NPIMap

Organization Active NPI

Fairview Express Care

  • Eyewear Supplier
  • Eagan, MN
National Provider Identifier
1750833562
Registry record updated Dec 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
FAIRVIEW EXPRESS CARE
Practice address
3305 Central Park Village Dr
Suite 160
Eagan, MN 55121-7707
Phone
(651) 405-5801
Fax
(651) 405-5801
NPI assigned
Oct 27, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2020

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

Authorized official

Name
Robert Andrew McCoy
Title
VP Revenue Management
Phone
(612) 672-6594

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

3305 Central Park Village Dr
Suite 160
Eagan, MN 55121-7707

Mailing address

2450 Riverside Ave
Minneapolis, MN 55454-1450

Other names 1

  • M Health Fairview Clinic - Eagan Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20081028000548 MN Part B Supplier - Clinic/Group Practice 3375645179 Receives reassigned benefits from 4,146 practitioners
This NPI is an additional NPI on the enrollment
O20220506000450 MN DME Supplier - Physician - Optometrist 3375645179 Practice locations: Eagan, MN

National Provider Directory

National Provider Directory
Tax ID family
Fairview Express Care20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Locations

6341 University Ave NE
Minneapolis, MN 55432
Phone (763) 427-9980

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Practitioners 1,978

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 1,978

NPI Registry JSON

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

{
    "created_epoch": "1477526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607990400000",
    "number": "1750833562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3305 CENTRAL PARK VILLAGE DR",
            "address_2": "SUITE 160",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551217707",
            "telephone_number": "651-405-5801",
            "fax_number": "651-405-5801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRVIEW EXPRESS CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-27",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A",
        "authorized_official_last_name": "MCCOY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "VP REVENUE MANAGEMENT",
        "authorized_official_telephone_number": "612-672-6594"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "M Health Fairview Clinic - Eagan",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Eagan, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.