Active NPI
Walter Hollifield Dorman, M.D.
- Rheumatology Physician
- Edina, MN
National Provider Identifier
1902800873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- 21028
- Practice address
- 7600 France Ave S Ste 5100
Edina, MN 55435 - Phone
- (952) 893-1959
- Fax
- (952) 893-1954
- NPI assigned
- Jun 9, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | 21028 | MN | Primary |
Addresses
Primary practice location
7600 France Ave S Ste 5100
Edina, MN 55435
Mailing address
7600 France Ave S Ste 5100
Edina, MN 55435-5924
Phone (952) 893-1959
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3200021 | Other | MN | MEDICA |
| 106158C477 | Other | MN | UCARE |
| 685592000 | Medicaid | MN | |
| 965162 | Other | MN | AFFORDABLE NETWORK |
| HP13178 | Other | MN | HEALTHPARTNERS |
| 66Q38DO | Other | MN | BLUE CROSS BLUE SHIELD |
| 24909 | Other | MN | AMERICA'S PPO |
| 411774839A002 | Other | MN | CHAMPUS |
| 660003751 | Other | MN | RR MEDICARE |
| 960080460002 | Other | MN | PREFERRED ONE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | walter.dorman.p1@direct.arc.nextgenshare.com |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21028 | MN | MD | Rheumatology Physician |
Organizations & group practices 1
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.
-
- Rheumatology Physician
- Edina, MN
- NPI 1447366919
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605657600000",
"number": "1902800873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7600 FRANCE AVE S STE 5100",
"city": "EDINA",
"state": "MN",
"postal_code": "554355924",
"telephone_number": "952-893-1959",
"fax_number": "952-893-1954"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7600 FRANCE AVE S STE 5100",
"city": "EDINA",
"state": "MN",
"postal_code": "55435",
"telephone_number": "952-893-1959",
"fax_number": "952-893-1954"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DORMAN",
"first_name": "WALTER",
"middle_name": "HOLLIFIELD",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-09",
"last_updated": "2020-11-18",
"certification_date": "2020-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "MN",
"license": "21028",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "3200021",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "106158C477",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "685592000",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AFFORDABLE NETWORK",
"identifier": "965162",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP13178",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "66Q38DO",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICA'S PPO",
"identifier": "24909",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "411774839A002",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "660003751",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "960080460002",
"state": "MN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "walter.dorman.p1@direct.arc.nextgenshare.com",
"affiliation": "N",
"address_1": "7600 France Ave S Ste 5100",
"city": "Edina",
"state": "MN",
"country_code": "US",
"postal_code": "55435",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.