Individual provider Active NPI

Alyce Anderson, MD, PHD

  • Dermatopathology Physician
  • Minneapolis, MN
National Provider Identifier
1770143992
Registry record updated Feb 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
License
77975 Issued in MN
Practice address
909 Fulton St SE
Minneapolis, MN 55455-4800
Phone
(612) 273-8383
NPI assigned
Jun 19, 2019
Last updated
Feb 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 77975 MN
Student in an Organized Health Care Education/Training Program 390200000X MT218362 PA
Dermatopathology Physician 207ND0900X 77975 MN Primary

Addresses

Primary practice location

909 Fulton St SE
Minneapolis, MN 55455-4800

Mailing address

909 Fulton St SE
Minneapolis, MN 55455-4800

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
I20240906003735 MN Practitioner - Dermatology 4385184175 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Pittsburgh School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

2900 Curve Crest Blvd W
Stillwater, MN 55082-5085
Phone (651) 471-5600

500 Harvard St SE
Minneapolis, MN 55455-0363
Phone (612) 672-7422

600 W 98TH St
Bloomington, MN 55420-4773
Phone (952) 885-6150

717 Delaware St SE
Suite 340
Minneapolis, MN 55414-2959
Phone (612) 672-7422

909 Fulton St SE
Minneapolis, MN 55455-4800
Phone (612) 672-7422

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions57
Skin biopsy31

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
77975MNMDDermatology Physician
MT218362PAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
University of Minnesota Health Clinics and Surgery Center Inc CurrentSince Sep 30, 2024 Accepting new patients
University of Minnesota Health Clinics and Surgery Center, Inc. CurrentSince Sep 30, 2024 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Express Care CurrentSince Sep 30, 2024 Accepting new patients
University of Minnesota Physicians CurrentSince Sep 30, 2024 Accepting new patients
University of Minnesota Physicians Current Accepting new patients
Healtheast Medical Research Institute CurrentSince Dec 1, 2025 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Healtheast Medical Research Insititue CurrentSince Dec 1, 2025 Accepting new patients
Fairview Express Care CurrentSince Sep 30, 2024 Accepting new patients
University of Minnesota Physicians CurrentSince Sep 30, 2024 Accepting new patients
Fairview Health Services Past Accepting new patients

Locations

516 Delaware St SE
Minneapolis, MN 55455
Phone (612) 625-3600

600 W 98th St
Minneapolis, MN 55420
Phone (952) 881-2651

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

720 Washington Ave SE
Ste 300
Minneapolis, MN 55414
Phone (612) 884-0331

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

2900 Curve Crest Blvd W
Stillwater, MN 55082
Phone (651) 471-5600

Interoperability endpoints

  • Direct secure messaging: aanderson1823126@fairview.direct-ci.com

Organizations & group practices 12

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.

Hospital & facility affiliations 3

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": "1560902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738886400000",
    "number": "1770143992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 FULTON ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554554800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 FULTON ST SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554554800",
            "telephone_number": "612-273-8383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "ALYCE",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-19",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MN",
            "license": "77975",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "MT218362",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "MN",
            "license": "77975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.