NPIMap

Individual provider Active NPI

Angela Wermerskirchen, M.D.

  • Family Medicine Physician
  • Plymouth, MN
National Provider Identifier
1780603431
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
44866 Issued in MN
Practice address
12805 Highway 55
Suite 111
Plymouth, MN 55441-3859
Phone
(763) 577-2060
Fax
(763) 577-2099
NPI assigned
Jul 19, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 44866 MN Primary

Addresses

Primary practice location

12805 Highway 55
Suite 111
Plymouth, MN 55441-3859

Mailing address

12805 Highway 55
Suite 111
Plymouth, MN 55441-3859
Phone (763) 577-2060

Other identifiers 1

IdentifierTypeStateIssuer
381K8WEOtherMNBLUE CROSS BLUE SHIELD

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
I20041202000277 MN Practitioner - Family Practice 2062478043 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

14500 99TH Ave N
Maple Grove, MN 55369-4730
Phone (763) 898-1000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
44866MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Clinics CurrentSince Apr 16, 2007 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Apr 16, 2007 Accepting new patients
Fairview Health Services CurrentSince Sep 2, 2008 Accepting new patients
Fairview Clinics CurrentSince Sep 2, 2008 Accepting new patients
Bridge Medical Supply, Inc. Past Accepting new patients
University of Minnesota Physicians Past Accepting new patients
University of Minnesota Physicians Past Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

14500 99th Ave N
Maple Grove, MN 55369
Phone (763) 898-1000

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

3033 Excelsior Blvd
Ste 275
Minneapolis, MN 55416
Phone (612) 827-4751

400 Stinson Blvd
Fl 2
Minneapolis, MN 55413
Phone (612) 672-2203

420 Delaware St SE
#126
Minneapolis, MN 55455
Phone (612) 626-2378

6320 Wedgwood Rd N
Osseo, MN 55311
Phone (763) 268-0400

12805 Highway 55
Ste 111
Plymouth, MN 55441
Phone (763) 383-6060

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

Interoperability endpoints

  • Direct secure messaging: awermerskirchen8998@fairview.direct-ci.com

Organizations & group practices 10

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 6

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": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1780603431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12805 HIGHWAY 55",
            "address_2": "SUITE 111",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554413859",
            "telephone_number": "763-577-2060",
            "fax_number": "763-577-2099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12805 HIGHWAY 55",
            "address_2": "SUITE 111",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554413859",
            "telephone_number": "763-577-2060",
            "fax_number": "763-577-2099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WERMERSKIRCHEN",
        "first_name": "ANGELA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "44866",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "381K8WE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

Verify at the official NPI Registry.