NPIMap

Individual provider Active NPI

Evan Welsch Jungbauer, MD

  • Family Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1841853769
Registry record updated Nov 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
68175 Issued in MN
Practice address
3270 W Lake St
Minneapolis, MN 55416-4512
Phone
(612) 775-1800
NPI assigned
Apr 16, 2019
Last updated
Nov 7, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X 68175 MN Primary

Addresses

Primary practice location

3270 W Lake St
Minneapolis, MN 55416-4512

Mailing address

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-9000

Other practice location 1

580 Rice St
Saint Paul, MN 55103-2148
Phone (651) 227-6551

Other practice location 2

13819 Hanson Blvd NW
Andover, MN 55304-7608
Phone (763) 572-5700

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ejungbauer206314@excellian.direct.allina.com Direct

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
I20201130001322 MN Practitioner - Family Practice 4183956568 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Chicago College of Medicine and Surgery, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Allina Health SystemGroup PAC ID 4587573613, shared by 89 NPIs, 3,844 clinicians

Practice addresses (Care Compare)

440 Elm St E
Annandale, MN 55302-1109
Phone (320) 682-5225

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Clinics CurrentSince Sep 1, 2020 Accepting new patients
Allina Health System Current Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Sep 1, 2020 Accepting new patients
Allina Health System Family Medicine Current Accepting new patients
Healtheast Medical Research Institute CurrentSince Sep 1, 2020 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Health Services CurrentSince Sep 1, 2020 Accepting new patients
Allina Health System Family Medicine CurrentSince Sep 12, 2022 Accepting new patients
Allina Health System CurrentSince Dec 31, 2022 Accepting new patients
Fairview Clinics CurrentSince Sep 1, 2020 Accepting new patients
Allina Health System CurrentSince Sep 12, 2022 Accepting new patients
NPI 1083910871 Family Medicine Past Accepting new patients
Fairview Express Care Past Accepting new patients

Locations

13819 Hanson Blvd NW
Andover, MN 55304
Phone (763) 572-5700

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

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

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

3270 W Lake St
Minneapolis, MN 55416
Phone (612) 775-1800

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

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

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

2945 Hazelwood St
Ste 100
Saint Paul, MN 55109
Phone (651) 232-7800

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

580 Rice St
Saint Paul, MN 55103
Phone (651) 227-6551

1875 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-6700

Interoperability endpoints

  • Direct secure messaging: ejungbauer206314@excellian.direct.allina.com

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1555372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1841853769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3270 W LAKE ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554164512",
            "telephone_number": "612-775-1800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "580 Rice St",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551032148",
            "country_code": "US",
            "telephone_number": "651-227-6551",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13819 Hanson Blvd NW",
            "address_purpose": "LOCATION",
            "city": "Andover",
            "state": "MN",
            "postal_code": "553047608",
            "country_code": "US",
            "telephone_number": "763-572-5700",
            "fax_number": "763-862-2091",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JUNGBAUER",
        "first_name": "EVAN",
        "middle_name": "WELSCH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-16",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "68175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ejungbauer206314@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "3270 W Lake St",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554164512",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.