NPIMap

Individual provider Active NPI

Jacob Charles Liston, MD

  • Internal Medicine Physician
  • Edina, MN
National Provider Identifier
1821210212
Registry record updated Jan 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
50056 Issued in MN
Practice address
6545 France Avenue South
Suite 510
Edina, MN 55435
Phone
(952) 927-7079
Fax
(952) 920-9758
NPI assigned
May 3, 2007
Last updated
Jan 7, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 50056 MN Primary

Addresses

Primary practice location

6545 France Avenue South
Suite 510
Edina, MN 55435

Mailing address

6545 France Avenue South
Suite 510
Edina, MN 55435
Phone (952) 927-7079

Other names 1

  • Dr. Jay Charles Liston Other name

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
I20071109000113 MN Practitioner - Internal Medicine 7012005085 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Minnesota Medical School, 2004
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)

1440 Duckwood Dr
Eagan, MN 55122-1451
Phone (651) 406-8860

1700 University Ave W
Saint Paul, MN 55104-3727
Phone (952) 914-1732

201 E Nicollet Blvd
Burnsville, MN 55337-5714
Phone (952) 892-2000

2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone (612) 672-6000

5200 Fairview Blvd
Wyoming, MN 55092-8013
Phone (651) 982-7000

600 W 98TH St
Bloomington, MN 55420-4773
Phone (952) 881-2651

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

6545 France Ave S
Suite 150
Edina, MN 55435-2180
Phone (952) 848-5600

911 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-3344

919 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-3344

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50056MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Jul 8, 2016 Accepting new patients
Fairview Clinics CurrentSince Jul 8, 2016 Accepting new patients
Fairview Health Services CurrentSince Oct 14, 2013 Accepting new patients
Fairview Health Services CurrentSince Oct 14, 2013 Accepting new patients
Fairview Clinics Past Accepting new patients

Locations

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

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

6405 France Ave S
Ste 440
Edina, MN 55435
Phone (952) 927-7004

6545 France Ave S
Ste 150
Edina, MN 55435
Phone (952) 848-5600

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

6545 France Ave S
Ste 510
Minneapolis, MN 55435
Phone (612) 927-7079

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

Interoperability endpoints

  • Direct secure messaging: jliston207764@fairview.direct-ci.com

Organizations & group practices 7

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 32

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199664000000",
    "number": "1821210212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6545 FRANCE AVENUE SOUTH",
            "address_2": "SUITE 510",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55435",
            "telephone_number": "952-927-7079",
            "fax_number": "952-920-9758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6545 FRANCE AVENUE SOUTH",
            "address_2": "SUITE 510",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "55435",
            "telephone_number": "952-927-7079",
            "fax_number": "952-920-9758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISTON",
        "first_name": "JACOB",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2008-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "50056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAY",
            "last_name": "LISTON",
            "middle_name": "CHARLES",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.