Individual provider Active NPI

Isaac Milton Engholm, D.O.

  • Family Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1881940864
Registry record updated Nov 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
65161 Issued in MN
Practice address
825 Nicollet Mall Ste 403
Minneapolis, MN 55402-2611
Phone
(612) 712-4423
Fax
(763) 284-0254
NPI assigned
Jul 27, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 65161 MN Primary

Addresses

Primary practice location

825 Nicollet Mall Ste 403
Minneapolis, MN 55402-2611

Mailing address

825 Nicollet Mall Ste 403
Minneapolis, MN 55402-2611
Phone (612) 712-4423

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address iengholm410647@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: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190530001323 MN Practitioner - Family Practice 4880828128 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2015
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)

6341 University Ave NE
Fridley, MN 55432-4946
Phone (763) 572-5700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services CurrentSince Nov 1, 2022 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Clinics CurrentSince Nov 1, 2022 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Clinics CurrentSince Nov 1, 2022 Accepting new patients
Fairview Express Care CurrentSince Nov 1, 2022 Accepting new patients
Fairview Express Care CurrentSince Nov 1, 2022 Accepting new patients
Fairview Health Services CurrentSince Nov 1, 2022 Accepting new patients
Fairview Clinics Current Accepting new patients
Summit Medical Center Past Accepting new patients
Fairview Clinics Past Accepting new patients

Locations

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

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

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

6341 University Ave NE
Minneapolis, MN 55432
Phone (763) 427-9980

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

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

1700 University Ave W
Saint Paul, MN 55104
Phone (612) 672-6740

1151 Silver Lake Rd NW
Saint Paul, MN 55112
Phone (612) 706-4500

Interoperability endpoints

  • Direct secure messaging: iengholm410647@excellian.direct.allina.com

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1343347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604966400000",
    "number": "1881940864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 NICOLLET MALL STE 403",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554022611",
            "telephone_number": "612-712-4423",
            "fax_number": "763-284-0254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 NICOLLET MALL STE 403",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554022611",
            "telephone_number": "612-712-4423",
            "fax_number": "763-284-0254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENGHOLM",
        "first_name": "ISAAC",
        "middle_name": "MILTON",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-27",
        "last_updated": "2020-11-10",
        "certification_date": "2020-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "65161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iengholm410647@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "825 Nicollet Mall Ste 403",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554022611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.