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SOUTHDALE PHYSICIANS, LLC
NPI 1124569249
Internal Medicine in Edina, MN

Active since March 09, 2017CLIA 24D2143216 · Waiver
6565 FRANCE AVE S STE 350, EDINA, MN 55435(612) 430-8120 Get Directions Write a Review

NPPES record last updated: February 17, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 17, 2025, Jun 18, 2024 (2 updates tracked since 2024).

About Southdale Physicians, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHDALE PHYSICIANS, LLC (NPI 1124569249) is a healthcare organization registered as an internal medicine in Edina, Minnesota and active in the NPI registry since March 2017. The organization holds a CLIA Waiver certificate valid through January 25, 2028 and lists Derek J Dagendesh, Office Administrator, as its authorized official.

NPPES Registry Identity

NPI1124569249
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameSOUTHDALE PHYSICIANS, LLC
Location Address6565 FRANCE AVE S STE 350Edina, MN 55435-2137
Mailing Address6565 France Ave S Ste 350Edina, MN 55435-2137
Phone(612) 430-8120
Organization SubpartNo
Authorized OfficialDerek J DagendeshOffice Administrator · (952) 999-4049
Enumeration DateMarch 9, 2017
Last NPPES UpdateFebruary 17, 20252 updates tracked since enumeration
NPPES CertifiedFebruary 17, 2025
✔ NPI 1124569249 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedDermatologyTaxonomy 207N00000X
6565 FRANCE AVE S STE 350, Edina, MN 55435
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D2143216

Southdale Physicians, LLC · Edina, MN
Active · expires Jan 25, 2028
CLIA Number24D2143216
Laboratory TypePhysician Office
Certificate Effective DateJanuary 26, 2026
Certificate Expiration DateJanuary 25, 2028
Laboratory DirectorMerlin E. Brown
Laboratory Phone(952) 999-4049
Laboratory LocationSouthdale Physicians, LLC6565 France Ave S #350, Edina, MN 55435
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROCKET SURGERY, LLC
Clinic/Center
6565 FRANCE AVE S STE 350
EDINA, MN 55435
Hennepin County (952) 999-9049
MRS. ASHLEY PAIGE WILLETTE CNP
Nurse Practitioner (Primary Care)
6565 FRANCE AVE S STE 350
EDINA, MN 55435
Hennepin County (952) 999-4049
DEBORAH M. NOWAK M.D.
Surgery
6565 FRANCE AVE S STE 350
EDINA, MN 55435
Hennepin County (612) 389-1093
DOCTOR'S HOUSE
Clinic/Center
6565 FRANCE AVE S STE 350
EDINA, MN 55435
Hennepin County (612) 836-9412
KINDRED HEALTH, LLC.
Clinic/Center (Primary Care)
6565 FRANCE AVE S STE 350
EDINA, MN 55435
Hennepin County (952) 999-4049
THREE SIXTY HEALTH INC
Psychiatry & Neurology (Psychiatry)
6565 FRANCE AVE S STE 350
EDINA, MN 55435
Hennepin County (952) 999-4049
GAMZE BALCI M.D.
Psychiatry & Neurology (Psychiatry)
6565 FRANCE AVE S STE 350
EDINA, MN 55435
Hennepin County (952) 999-4049

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southdale Physicians, LLC's NPI number?

The NPI number for Southdale Physicians, LLC is 1124569249. It was assigned to this organization in the NPPES registry on March 9, 2017.

Where is Southdale Physicians, LLC located?

Southdale Physicians, LLC is located at 6565 France Ave S Ste 350, Edina, MN 55435. The listed phone number is (612) 430-8120.

What is Southdale Physicians, LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Southdale Physicians, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D2143216) is associated with this NPI, valid through January 25, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Southdale Physicians, LLC was last updated on February 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.