Southdale Physicians, LLC
NPI 1124569249ActiveOrganization· Internal Medicine· Edina, MN
Internal Medicine in Edina, Minnesota, registered in NPPES in March 2017. The authorized official on file is Derek J. Dagendesh, Office Administrator. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1124569249 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Mar 9, 2017 |
| Last updated in NPPES | Feb 17, 2025 |
| Certified by provider | Feb 17, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Internal Medicine Primary | 207R00000X | — | — |
| Dermatology | 207N00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (MN) |
|---|
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