NPIMap

Individual provider Active NPI

Lavanya Namballa, MD

  • Internal Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1881030658
Registry record updated Dec 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
65322 Issued in MN
Practice address
1527 E Lake St
Minneapolis, MN 55407-6700
Phone
(612) 721-6511
NPI assigned
May 20, 2013
Last updated
Dec 17, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 17628 NV
Internal Medicine Physician 207R00000X 65322 MN Primary

Addresses

Primary practice location

1527 E Lake St
Minneapolis, MN 55407-6700

Mailing address

400 Stinson Blvd FL 2
Minneapolis, MN 55413-2614

Other practice location 1

1155 Mill St # W11
Reno, NV 89502-1576
Phone (775) 327-5174

Other practice location 2

1075 N Hills Blvd Ste 180
Reno, NV 89506-6799
Phone (775) 982-5000

Other identifiers 1

IdentifierTypeStateIssuer
14137435OtherCAQH

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
I20191231002108 MN Practitioner - Internal Medicine 9234446097 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1998
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)

600 W 98TH St
Bloomington, MN 55420-4773
Phone (952) 885-6150

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
17628NVMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Jan 10, 2020 Accepting new patients
Fairview Clinics CurrentSince Jan 10, 2020 Accepting new patients
Fairview Health Services CurrentSince Jan 10, 2020 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Clinics Past Accepting new patients
Fairview Express Care PastSince Dec 22, 2019 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

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

600 W 98th St
Minneapolis, MN 55420
Phone (952) 881-2651

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

Interoperability endpoints

  • Direct secure messaging: lnamballa498092@fairview.direct-ci.com

Organizations & group practices 9

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 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": "1369008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576540800000",
    "number": "1881030658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 STINSON BLVD FL 2",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554132614",
            "fax_number": "775-982-5496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1527 E LAKE ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554076700",
            "telephone_number": "612-721-6511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1155 Mill St # W11",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895021576",
            "country_code": "US",
            "telephone_number": "775-327-5174",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1075 N Hills Blvd Ste 180",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895066799",
            "country_code": "US",
            "telephone_number": "775-982-5000",
            "fax_number": "775-982-3900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NAMBALLA",
        "first_name": "LAVANYA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-20",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "17628",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "65322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14137435",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.