Fairview Orthotics and Prosthetics – Prosthetic/Orthotic Supplier, NPI 1396708038
Prosthetic/Orthotic Supplier
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Fairview Orthotics and Prosthetics
1700 UNIVERSITY AVE W
SAINT PAUL, MN 551043727
Phone: (612) 672-6740
Fax: (612) 884-3592
Type: Mailing
Club West Parkway Northeast, Blaine, Anoka County, Minnesota, 55434, United States
STE 220
BLAINE, MN 554495866
Phone: (763) 852-6401
Fax: (763) 852-6402
Type: Location
Mill Valley Market, 1221, Theodore Wirth Parkway, Glenwood Junction, Minneapolis, Hennepin County, Minnesota, 55422, United States
MINNEAPOLIS, MN 554401221
Phone: (612) 672-6724
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-09-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-06-30 (712 days ago).
Enrollment records
1
Earliest due date
2024-06-30
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20100930051714 | O | Medical Supply Company With Orthotic-Prosthetic | MN | 2024-06-30 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 55104)
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