Individual provider Active NPI

David C Wahoff, MD

  • Pediatric Surgery Physician
  • Minneapolis, MN
National Provider Identifier
1952362535
Registry record updated Aug 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
35534 Issued in MN
Practice address
2530 Chicago Ave
#550
Minneapolis, MN 55404-4289
Phone
(612) 813-8000
Fax
(612) 813-8005
NPI assigned
Mar 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery Physician 2086S0120X 35534 MN Primary

Addresses

Primary practice location

2530 Chicago Ave
#550
Minneapolis, MN 55404-4289

Mailing address

2530 Chicago Ave
#550
Minneapolis, MN 55404-4289
Phone (612) 813-8000

Other identifiers 1

IdentifierTypeStateIssuer
007217600MedicaidMN

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
I20071018000050 MN Practitioner - Pediatric MedicinePractitioner - General Surgery 3678477577 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Surgical Associates LTD Pediatric Surgery CurrentSince Jun 4, 2012 Accepting new patients
Childrens Health Care Past Accepting new patients
Gillette Children'S Specialty Healthcare Past Accepting new patients

Locations

2530 Chicago Ave
Minneapolis, MN 55404
Phone (612) 813-6000

2530 Chicago Ave
Ste 550
Minneapolis, MN 55404
Phone (612) 810-8000

4530 77th St W
Ste 205
Minneapolis, MN 55435
Phone (952) 835-3375

347 Smith Ave N
Ste 502
Saint Paul, MN 55102
Phone (651) 248-2113

5354 Edgewood Dr
Saint Paul, MN 55112

Interoperability endpoints

  • Direct secure messaging: david.wahoff@avera.sdhealthlink.net
  • Direct secure messaging: david.wahoff@psal.eclinicaldirectplus.com

Organizations & group practices 3

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344384000000",
    "number": "1952362535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 CHICAGO AVE",
            "address_2": "#550",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044289",
            "telephone_number": "612-813-8000",
            "fax_number": "612-813-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 CHICAGO AVE",
            "address_2": "#550",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044289",
            "telephone_number": "612-813-8000",
            "fax_number": "612-813-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHOFF",
        "first_name": "DAVID",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2012-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "MN",
            "license": "35534",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007217600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.