NPIMap

Individual provider Active NPI

Craig Stuart Walvatne, M.D.

  • Vascular Surgery Physician
  • Blaine, MN
National Provider Identifier
1972515427
Registry record updated Jul 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
31967 Issued in MN
Practice address
11855 Ulysses St NE
220
Blaine, MN 55434-3947
Phone
(763) 427-8547
Fax
(763) 576-5394
NPI assigned
Aug 13, 2006
Last updated
Jul 29, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 27345-020 WI
Surgery Physician 208600000X 31967 MN
Surgical Critical Care Physician 2086S0102X 31967 MN
Surgical Critical Care Physician 2086S0102X 27345-020 WI
Vascular Surgery Physician 2086S0129X 31967 MN Primary

Addresses

Primary practice location

11855 Ulysses St NE
220
Blaine, MN 55434-3947

Mailing address

3887 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2518
Phone (763) 427-8547

Other identifiers 4

IdentifierTypeStateIssuer
476753500MedicaidMN
1778251MedicaidMN
HSZ009OtherMNMEDICARE GRP B
301T6WAOtherMNBCBS

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
I20071218000558 MN Practitioner - Vascular SurgeryPractitioner - General SurgeryPractitioner - Critical Care (Intensivists) 5496845174 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: Critical Care (Intensivists), General Surgery
Education
University of Minnesota Medical School, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vascular Surgery Associates PAGroup PAC ID 2769448950, 2 clinicians

Practice addresses (Care Compare)

11855 Ulysses St NE
Suite 220
Blaine, MN 55434-4181
Phone (763) 427-8547

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal70
Removal of tissue313

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
31967MNMDSurgery Physician
27345-020WIMDSurgical Critical Care Physician

Interoperability endpoints

  • Direct secure messaging: vascularsurgeryassociates.craigwalvatne@117099.advancedmd-direct.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 24

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753747200000",
    "number": "1972515427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3887 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332518",
            "telephone_number": "763-427-8547",
            "fax_number": "763-576-5394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11855 ULYSSES ST NE",
            "address_2": "220",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554343947",
            "telephone_number": "763-427-8547",
            "fax_number": "763-576-5394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALVATNE",
        "first_name": "CRAIG",
        "middle_name": "STUART",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "27345-020",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MN",
            "license": "31967",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "MN",
            "license": "31967",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "WI",
            "license": "27345-020",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MN",
            "license": "31967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "476753500",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1778251",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GRP B",
            "identifier": "HSZ009",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "301T6WA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blaine, MN

Sources for this page

Verify at the official NPI Registry.