Individual provider Active NPI

Maria De Lourdes Azevedo Gomes, MD

  • Diagnostic Radiology Physician
  • Robbinsdale, MN
National Provider Identifier
1932109980
Registry record updated Jun 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
40553 Issued in MN
Practice address
3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone
(763) 559-2171
Fax
(763) 694-9000
NPI assigned
Jul 29, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2012

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 40553 MN Primary
Vascular & Interventional Radiology Physician 2085R0204X 40553 MN
Body Imaging Physician 2085B0100X 40553 MN
Nuclear Radiology Physician 2085N0904X 40553 MN

Addresses

Primary practice location

3300 Oakdale Ave N
Robbinsdale, MN 55422-2926

Mailing address

2800 Campus Dr
Ste 10
Plymouth, MN 55441-2645
Phone (763) 559-2171

Other identifiers 1

IdentifierTypeStateIssuer
993017500MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20040508000293 MN Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 8628067360 Reassigns benefits to 4 organizations
I20230314003098 WI Practitioner - Diagnostic Radiology 8628067360 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional RadiologyAlso: Diagnostic Radiology
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minneapolis Radiology Associates LTDGroup PAC ID 5698661007, 44 clinicians
West Imaging LLCGroup PAC ID 7315833720, 29 clinicians
North Memorial Health CareGroup PAC ID 0042123028, 502 clinicians
Minnesota Diagnostic Imaging Partners LLCGroup PAC ID 5890681209, 32 clinicians

Practice addresses (Care Compare)

2800 Campus Dr
Suite 10
Plymouth, MN 55441-2669
Phone (763) 559-2171

3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone (763) 581-5400

9855 Hospital Dr
Suite 150
Maple Grove, MN 55369-4776
Phone (763) 398-6341

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal20

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
40553MNMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Memorial Health Care Current Accepting new patients
Minnesota Diagnostic Imaging Partners, LLC Diagnostic Radiology CurrentSince May 15, 2010 Accepting new patients
West Imaging, LLC Diagnostic Radiology CurrentSince Oct 1, 2004 Accepting new patients
Hudson Imaging Partners LLC Diagnostic Radiology CurrentSince Jan 18, 2023 Accepting new patients
Minneapolis Radiology Associates, LTD. Body Imaging CurrentSince Jun 1, 2003 Accepting new patients
North Memorial Health Care CurrentSince Jan 1, 2014 Accepting new patients

Locations

9875 Hospital Dr
Maple Grove, MN 55369
Phone (763) 581-1000

9855 Hospital Dr
Ste 150
Maple Grove, MN 55369
Phone (763) 398-6341

2955 Xenium Ln N
Ste 40
Plymouth, MN 55441
Phone (763) 398-2203

2855 Campus Dr
Plymouth, MN 55441
Phone (763) 577-7000

2800 Campus Dr
Ste 30
Plymouth, MN 55441
Phone (763) 398-4000

2800 Campus Dr
Ste 20
Plymouth, MN 55441
Phone (763) 398-8700

2800 Campus Dr
Ste 10
Plymouth, MN 55441
Phone (763) 398-4400

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

2651 Hillcrest Dr
Ste 103
Hudson, WI 54016
Phone (763) 559-2171

Organizations & group practices 6

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 5

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": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340668800000",
    "number": "1932109980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 CAMPUS DR",
            "address_2": "STE 10",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554412645",
            "telephone_number": "763-559-2171",
            "fax_number": "763-694-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 OAKDALE AVE N",
            "city": "ROBBINSDALE",
            "state": "MN",
            "postal_code": "554222926",
            "telephone_number": "763-559-2171",
            "fax_number": "763-694-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMES",
        "first_name": "MARIA",
        "middle_name": "DE LOURDES AZEVEDO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-29",
        "last_updated": "2012-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "40553",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "MN",
            "license": "40553",
            "primary": false
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "MN",
            "license": "40553",
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "MN",
            "license": "40553",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "993017500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Robbinsdale, MN

Sources for this page

Verify at the official NPI Registry.