NPIMap

Individual provider Active NPI

Khalid Azzam, M.D.

  • Orthopaedic Surgery Physician
  • Saint Paul, MN
National Provider Identifier
1811128416
Registry record updated Oct 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
65384 Issued in MN
Practice address
435 Phalen Blvd
Saint Paul, MN 55130
Phone
(651) 254-8379
Fax
(651) 254-8300
NPI assigned
Jul 30, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 01075391A IN
Orthopaedic Surgery Physician 207X00000X 6172 NE
Orthopaedic Surgery Physician 207X00000X 65384 MN Primary

Addresses

Primary practice location

435 Phalen Blvd
Saint Paul, MN 55130

Mailing address

8170 33Rd Ave
Ms 21110Q
Bloomington, MN 55425-4516
Phone (651) 254-8739

Other practice location 1

13100 E 136th St
Ste 2000
Fishers, IN 46037-9440
Phone (317) 688-5980

Other identifiers 1

IdentifierTypeStateIssuer
201319820MedicaidIN

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
I20190717002624 MN Practitioner - Orthopedic Surgery 0042436917 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

435 Phalen Blvd
Saint Paul, MN 55130-5302
Phone (651) 291-2848

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement15
Knee replacement1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
65384MNMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. CurrentSince Aug 1, 2019 Accepting new patients
Group Health, Inc. CurrentSince Aug 1, 2019 Accepting new patients
Tria Orthopaedic Center LLC CurrentSince Oct 1, 2020 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Express Care CurrentSince Feb 20, 2023 Accepting new patients
Healtheast Medical Research Insititue CurrentSince Feb 20, 2023 Accepting new patients
Fairview Express Care CurrentSince Feb 20, 2023 Accepting new patients
Tria Orthopaedic Center LLC Orthopaedic Surgery CurrentSince Oct 1, 2020 Accepting new patients
Healtheast Medical Research Institute CurrentSince Feb 20, 2023 Accepting new patients
Fairview Express Care Current Accepting new patients
Regions Hospital Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

8100 Northland Dr
Minneapolis, MN 55431
Phone (952) 831-1626

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

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

435 Phalen Blvd
Saint Paul, MN 55130
Phone (651) 254-3200

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

155 Radio Dr
Woodbury, MN 55125
Phone (952) 883-6212

5200 Fairview Blvd
Wyoming, MN 55092
Phone (651) 464-4611

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1248912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571616000000",
    "number": "1811128416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE",
            "address_2": "MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516",
            "telephone_number": "651-254-8739",
            "fax_number": "651-254-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 PHALEN BLVD",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "55130",
            "telephone_number": "651-254-8379",
            "fax_number": "651-254-8300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13100 E 136th St",
            "address_2": "Ste 2000",
            "address_purpose": "LOCATION",
            "city": "Fishers",
            "state": "IN",
            "postal_code": "460379440",
            "country_code": "US",
            "telephone_number": "317-688-5980",
            "fax_number": "317-678-3222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AZZAM",
        "first_name": "KHALID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-30",
        "last_updated": "2019-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "IN",
            "license": "01075391A",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NE",
            "license": "6172",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MN",
            "license": "65384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201319820",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.