Active NPI
Djo, LLC
- Durable Medical Equipment & Medical Supplies
- Saint Paul, MN
National Provider Identifier
1780459388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- Legal business name
- DJO, LLC
- Practice address
- 2400 County Road D W Ste 110
Saint Paul, MN 55112-8503 - Phone
- (612) 445-9191
- Fax
- (844) 277-2075
- NPI assigned
- Nov 24, 2023
- Organization subpart
- Yes
- Parent organization
- DJO, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Andres Moreno III
- Title
- Government Payor Relations Advisor
- Phone
- (704) 749-6291
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | Primary | ||
| Prosthetic/Orthotic Supplier | 335E00000X |
Addresses
Primary practice location
2400 County Road D W Ste 110
Saint Paul, MN 55112-8503
Mailing address
2900 Lake Vista Dr Ste 200
Lewisville, TX 75067-3889
Phone (704) 749-6291
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241015002239 | MN | DME Supplier - Medical Supply Company With Orthotic Personnel | 1456472703 | Practice locations: Saint Paul, MN |
Other NPIs with the same Medicare PAC ID 6
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Djo, LLC | Heat & Cold Applications|Osteogenesis Stimulators|Canes and/or Crutches|Walkers|Orthoses: Off-The-Shelf | Accepts assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Djo LLC
- Part of
- Djo LLC
Other organizations with this tax ID 8
Organizations that report the same tax identification number in the National Provider Directory.
-
- Durable Medical Equipment & Medical Supplies
- Holt, MI
- NPI 1003632084
-
- Durable Medical Equipment & Medical Supplies
- Apollo Beach, FL
- NPI 1023296035
-
- Durable Medical Equipment & Medical Supplies
- Hixson, TN
- NPI 1033980271
-
- Durable Medical Equipment & Medical Supplies
- Overland Park, KS
- NPI 1053195446
-
- Durable Medical Equipment & Medical Supplies
- Carlsbad, CA
- NPI 1497731533
-
- Durable Medical Equipment & Medical Supplies
- Vista, CA
- NPI 1518708320
-
- Durable Medical Equipment & Medical Supplies
- Goshen, IN
- NPI 1861267460
-
- Durable Medical Equipment & Medical Supplies
- Lewisville, TX
- NPI 1982345302
Member organizations 12
Organizations listed as members of this organization in the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1700784000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1764892800000",
"number": "1780459388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 LAKE VISTA DR STE 200",
"city": "LEWISVILLE",
"state": "TX",
"postal_code": "750673889",
"telephone_number": "704-749-6291",
"fax_number": "704-831-8300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 COUNTY ROAD D W STE 110",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551128503",
"telephone_number": "612-445-9191",
"fax_number": "844-277-2075"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DJO, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "DJO, LLC",
"enumeration_date": "2023-11-24",
"last_updated": "2025-12-05",
"certification_date": "2025-12-05",
"status": "A",
"authorized_official_last_name": "MORENO",
"authorized_official_first_name": "ANDRES",
"authorized_official_title_or_position": "GOVERNMENT PAYOR RELATIONS ADVISOR",
"authorized_official_telephone_number": "704-749-6291",
"authorized_official_name_prefix": "Mr.",
"authorized_official_name_suffix": "III"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": true
},
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.