NPIMap

Organization Active NPI

Eye Clinic of Faribault PA

  • Clinic/Center
  • Faribault, MN
National Provider Identifier
1831154681
Registry record updated Jan 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
5584709 Issued in MN
Legal business name
EYE CLINIC OF FARIBAULT PA
Practice address
1575 20TH St NW Ste 101
Faribault, MN 55021-2930
Phone
(507) 332-9900
Fax
(507) 332-6800
NPI assigned
Apr 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2021

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

Authorized official

Name
Michael G RichieNPI 1679594972
Title
MD/Owner
Phone
(507) 332-9900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 5584709 MN Primary

Addresses

Primary practice location

1575 20TH St NW Ste 101
Faribault, MN 55021-2930

Mailing address

1575 20TH St NW Ste 101
Faribault, MN 55021-2930
Phone (507) 332-9900

Other identifiers 2

IdentifierTypeStateIssuer
DA3675OtherMNRAILROAD MEDICARE
496436500MedicaidMN

Other names 1

  • Richie Eye Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Direct@RichieEyeClinicFaribaultMN.CompulinkDirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040127000937 MN Part B Supplier - Clinic/Group Practice 9436052677 Receives reassigned benefits from 17 practitioners
Practice locations: Waterville, MN; Northfield, MN; Montgomery, MN; Medford, MN; Faribault, MN; Le Sueur, MN; Le Center, MN; Kenyon, MN
O20100930020432 MN DME Supplier - Physician - Optometrist 9436052677 Practice locations: Faribault, MN

Laboratory certificates & supplier records

Derived by NPIMap

These 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

SupplierSuppliesMedicare assignment
Richie Eye Clinic1575 20TH St NW, Faribault, MN 55021-2930(507) 332-9900 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Jan 1, 2001

National Provider Directory

National Provider Directory

Locations

1575 20th St NW
Ste 101
Faribault, MN 55021
Phone (507) 332-6800

108 3rd St NE
Medford, MN 55049

399 Lexington Ave NW
Montgomery, MN 56069

710 Division St S
Northfield, MN 55057
Phone (507) 645-2212

205 1st St N
Waterville, MN 56096
Phone (507) 362-4245

Interoperability endpoints

  • Direct secure messaging: direct@richieeyeclinicfaribaultmn.compulinkdirect.com

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610323200000",
    "number": "1831154681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1575 20TH ST NW STE 101",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550212930",
            "telephone_number": "507-332-9900",
            "fax_number": "507-332-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 20TH ST NW STE 101",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550212930",
            "telephone_number": "507-332-9900",
            "fax_number": "507-332-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE CLINIC OF FARIBAULT PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-17",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A",
        "authorized_official_last_name": "RICHIE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "507-332-9900"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": "5584709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DA3675",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "496436500",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Direct@RichieEyeClinicFaribaultMN.CompulinkDirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct practice email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1575 20th St NW Ste 101",
            "city": "Faribault",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550212930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Richie Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Richie Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Faribault, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; 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.

Verify at the official NPI Registry.