Christopher J Kovanda, MEDICAL DOCTOR

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

41657 Issued in MN

Practice address

4999 France Ave S Ste 210
Edina, MN 55410-2168

Phone

(612) 335-9032

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

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.

• Kovanda Plastic Surgery, PLLC

  • Plastic and Reconstructive Surgery Physician
  • Edina, MN
  • NPI 1447484159
  Authorized official Same address or phone
• Paparella Ear Head & Neck Institute PA

  • Otolaryngology Physician
  • Minneapolis, MN
  • NPI 1881687119
  NPD (past)
• Southhealth ASC, LLC

  dba Edina Specialty Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Edina, MN
  • NPI 1154840064
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575936000000",
    "number": "1861501082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9325 UPLAND LN N STE 205",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694474",
            "telephone_number": "763-416-0676",
            "fax_number": "763-416-0476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4999 FRANCE AVE S STE 210",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554102168",
            "telephone_number": "612-335-9032"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9325 Upland Ln N Ste 205",
            "address_purpose": "LOCATION",
            "city": "Maple Grove",
            "state": "MN",
            "postal_code": "553694474",
            "country_code": "US",
            "telephone_number": "763-416-0676",
            "fax_number": "763-416-0476",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOVANDA",
        "first_name": "CHRISTOPHER",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MEDICAL DOCTOR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "MN",
            "license": "41657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32594400",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "240006520",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "40B11KO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "852226000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "1312285",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA LICENSE",
            "identifier": "41657",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP28575",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA PRIMARY",
            "identifier": "1300021",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "123451",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERREDONE",
            "identifier": "960011020119",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• George Matthen Koshy, M.D.
• Robin Koska, CES, OTR/L
• Abigail Rose Koski, DO
• Larry William Kotek, M.D.
• Kovanda Plastic Surgery, PLLC
• Aubrey Krahn, PT
• David M Krakowski I
• Jill Anne Kramer, MSSW, LICSW
• Michael Thomas Kratz, DDS
• Karen Krenik, MD

• Plastic Surgery Physician in Edina, MN
• Providers in Edina, MN by specialty
• Plastic Surgery Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.