Active NPI
Darrell G Boychuk, DDS, MS
- Orofacial Pain Dentistry
- Saint Paul, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orofacial Pain Dentistry
- License
- D13340
- Practice address
- 2500 Como Ave
Saint Paul, MN 55108-1460 - Phone
- (651) 641-6200
- Fax
- (651) 641-6295
- NPI assigned
- Sep 19, 2007
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 58751 | CA | |
| General Practice Dentistry | 1223G0001X | 13340 | MN | |
| Orofacial Pain Dentistry | 1223X2210X | D13340 | MN | Primary |
Addresses
Primary practice location
2500 Como Ave
Saint Paul, MN 55108-1460
Mailing address
8170 33Rd Ave S # Ms 21110Q
Minneapolis, MN 55425-4516
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: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Oral Surgery
- Education
- University of Alberta Faculty of Dentistry, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
8515 Eagle Point Blvd
Lake Elmo, MN 55042-8624
Phone (651) 523-9950
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 244 | CA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Group Health, Inc. | Dentist | Current | Accepting new patients |
| Group Health Plan, Inc. | Current | Accepting new patients | |
| Group Health, Inc. | Current | Accepting new patients |
Locations
8515 Eagle Point Blvd
Lake Elmo, MN 55042
Phone (651) 523-9950
8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375
8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600
2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600
3930 Northwoods Dr
Saint Paul, MN 55112
Phone (651) 490-6775
2500 Como Ave
Saint Paul, MN 55108
Phone (651) 641-6200
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba HealthPartners Medical Group
- Multi-Specialty Clinic/Center
- Minneapolis, MN
- NPI 1710924683
-
dba HealthPartners Well@Work-Anoka County
- Health Service Clinic/Center
- Anoka, MN
- NPI 1962704346
-
dba HealthPartners Midway Residency Dental
- General Practice Dentistry
- Saint Paul, MN
- NPI 1952042053
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664928000000",
"number": "1962698340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8170 33RD AVE S # MS 21110Q",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554254516",
"fax_number": "651-641-6220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 COMO AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551081460",
"telephone_number": "651-641-6200",
"fax_number": "651-641-6295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOYCHUK",
"first_name": "DARRELL",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-19",
"last_updated": "2022-10-05",
"certification_date": "2022-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "58751",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "13340",
"primary": false
},
{
"code": "1223X2210X",
"taxonomy_group": "",
"desc": "Dentist, Orofacial Pain",
"state": "MN",
"license": "D13340",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.