NPIMap

Individual provider Active NPI

Oliver Tan Phan, MD

  • Nephrology Physician
  • Edina, MN
National Provider Identifier
1942463229
Registry record updated Jan 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
57455 Issued in MN
Practice address
6363 France Ave S
Suite 400
Edina, MN 55435-2129
Phone
(763) 221-3201
NPI assigned
Jul 7, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 20, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 57455 MN Primary

Addresses

Primary practice location

6363 France Ave S
Suite 400
Edina, MN 55435-2129

Mailing address

6363 France Ave S
Suite 400
Edina, MN 55435-2129
Phone (763) 221-3201

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
I20140630002198 MN Practitioner - Nephrology 4082862909 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of Minnesota Medical School, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fairview Health ServicesGroup PAC ID 1951213057, 677 clinicians
Intermed Consultants Dialysis PLLCGroup PAC ID 7012225105, 11 clinicians
Intermed Consultants,LTD.Group PAC ID 8022033372, 17 clinicians

Practice addresses (Care Compare)

14101 Fairview Dr
Burnsville, MN 55337-2537

1700 University Ave W
Saint Paul, MN 55104-3727

201 E Nicollet Blvd
Burnsville, MN 55337-5714
Phone (952) 892-2000

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

6600 France Ave S
Suite 162
Edina, MN 55435-1802
Phone (952) 920-2070

911 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-1313

919 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-3344

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Intermed Consultants Dialysis, PLLC Nephrology CurrentSince Sep 15, 2015 Accepting new patients
Intermed Consultants,LTD. Nephrology CurrentSince Aug 1, 2014 Accepting new patients
Fairview Clinics CurrentSince Dec 29, 2020 Accepting new patients
Fairview Health Services Current Accepting new patients

Locations

201 E Nicollet Blvd
Burnsville, MN 55337
Phone (952) 892-2000

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

6363 France Ave S
Ste 400
Minneapolis, MN 55435
Phone (651) 312-1700

6600 France Ave S
Ste 162
Minneapolis, MN 55435
Phone (612) 920-2070

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

5354 Edgewood Dr
Saint Paul, MN 55112

Interoperability endpoints

  • Direct secure messaging: oliver.phan@direct.davitaphysiciansolutions.com

Organizations & group practices 5

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 11

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": "1215388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453248000000",
    "number": "1942463229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6363 FRANCE AVE S",
            "address_2": "SUITE 400",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352129",
            "telephone_number": "763-221-3201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6363 FRANCE AVE S",
            "address_2": "SUITE 400",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352129",
            "telephone_number": "763-221-3201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "OLIVER",
        "middle_name": "TAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-07",
        "last_updated": "2016-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MN",
            "license": "57455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.