NPIMap

Individual provider Active NPI

Ilya Perepelitsyn, MD

  • Otolaryngology/Facial Plastic Surgery Physician
  • Minneapolis, MN
National Provider Identifier
1992795058
Registry record updated Jun 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
49351 Issued in MN
Practice address
2211 Park Ave
Minneapolis, MN 55404-3711
Phone
(612) 871-1144
Fax
(612) 871-2012
NPI assigned
Oct 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 219565 MA
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 49351 MN Primary

Addresses

Primary practice location

2211 Park Ave
Minneapolis, MN 55404-3711

Mailing address

2211 Park Ave
Minneapolis, MN 55404-3711
Phone (612) 871-1144

Other identifiers 4

IdentifierTypeStateIssuer
305473200MedicaidMN
AA11436OtherMAHARVARD PILGRIM
J27270OtherMABLUE CROSS BLUE SHIELD
34756700MedicaidWI

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
I20070621000141 MN Practitioner - Otolaryngology 6103896006 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Tufts University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ear Nose and Throat Specialty Care of Minnesota PAGroup PAC ID 3274524020, 46 clinicians

Practice addresses (Care Compare)

6099 Wayzata Blvd
Suite 200
St Louis Park, MN 55416-5538
Phone (612) 871-1144

6525 France Ave S
Suite 325
Edina, MN 55435-2187
Phone (612) 871-1144

9822 Hospital Dr
Maple Grove, MN 55369-4648
Phone (612) 871-1144

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.11 of 100Reported as group
Quality
63.28
Promoting interoperability
91
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue31

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ear Nose & Throat Specialty Care of Minnesota PA CurrentSince Jul 1, 2007 Accepting new patients

Locations

9550 Upland Ln N
Ste 200
Maple Grove, MN 55369
Phone (612) 871-1144

6525 France Ave S
Ste 325
Minneapolis, MN 55435
Phone (952) 920-4595

2211 Park Ave
Minneapolis, MN 55404
Phone (612) 871-1144

6099 Wayzata Blvd
Ste 200
St Louis Park, MN 55416
Phone (612) 871-1144

Interoperability endpoints

  • Direct secure messaging: ilya.perepelitsyn@entsc.eclinicaldirectplus.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 and National Provider Directory roles.

Hospital & facility affiliations 35

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

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371081600000",
    "number": "1992795058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043711",
            "telephone_number": "612-871-1144",
            "fax_number": "612-871-2012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043711",
            "telephone_number": "612-871-1144",
            "fax_number": "612-871-2012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREPELITSYN",
        "first_name": "ILYA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-28",
        "last_updated": "2013-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "MA",
            "license": "219565",
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "MN",
            "license": "49351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "305473200",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "AA11436",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "J27270",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34756700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.