Unknown Individual – Internal Medicine Physician, NPI 1942353974
Excluded from federal healthcare programs (Medicare/Medicaid)
This provider is listed on the OIG List of Excluded Individuals/Entities (LEIE). Exclusion effective: 2009-12-20. Reason: License revocation, suspension, or surrender.
Internal Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Unknown Individual
BLUE IRIS CENTER FOR THERAPEUTIC SERVICES LLC
6607 18TH AVE S SUITE 201
RICHFIELD, MN 55423
Phone: (612) 445-4040
Fax: (612) 445-4041
Type: Location
4916, 30th Avenue South, Keewaydin, Nokomis, Minneapolis, Hennepin County, Minnesota, 55417, United States
MINNEAPOLIS, MN 554171308
Phone: (612) 721-9216
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
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.
No Medicare enrollment or revalidation data available for this provider in our database.
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 55423)
Loading plans...
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.