NPIMap

Individual provider Active NPI

Jessica M Butanis, DO

  • Internal Medicine Physician
  • Alexandria, MN
National Provider Identifier
1003220799
Registry record updated Jan 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
61656 Issued in MN
Practice address
610 30TH Ave W
Alexandria, MN 56308-3426
Phone
(320) 763-5123
Fax
(320) 763-7883
NPI assigned
Jun 20, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 61656 MN Primary
Internal Medicine Physician 207R00000X R10068 IA

Addresses

Primary practice location

610 30TH Ave W
Alexandria, MN 56308-3426

Mailing address

610 30TH Avenue West
Alexandria, MN 56308
Phone (320) 763-5123

Other identifiers 2

IdentifierTypeStateIssuer
H400413191OtherMNMEDICARE
1003220799MedicaidMN

Other names 1

  • Jessica Peterson Former name

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
I20170926000150 MN Practitioner - Internal Medicine 7911123849 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Alomere Health 123 clinicians

Practice addresses (Care Compare)

610 30TH Ave W
Alexandria, MN 56308-3426
Phone (320) 763-5123

Hospital & facility affiliations

  • Vivie Home Health Home health agency, Alexandria, MN, CCN 248096
  • Aveanna Home Health Home health agency, Waite Park, MN, CCN 247185
  • Horizon Public Health Hospice, Alexandria, MN, CCN 241548
  • Alomere Health Hospital, Alexandria, MN, CCN 240030
  • Centracare - St. Cloud Hospital Hospital, Saint Cloud, MN, CCN 240036
  • Glacial Ridge Hospital Hospital, Glenwood, MN, CCN 241376
  • Prairie Ridge Hospital and Health Services Hospital, Elbow Lake, MN, CCN 241379
  • Centracare Health System - Sauk Centre Hospital, Sauk Centre, MN, CCN 241368
  • Knute Nelson Care Center Nursing home, Alexandria, MN, CCN 245435
  • Galeon Nursing home, Osakis, MN, CCN 245465

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions24
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R10068IAMDInternal Medicine Physician
61656MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alomere Health CurrentSince Jan 1, 2026 Accepting new patients
Alomere Health CurrentSince Jan 1, 2026 Accepting new patients
Alexandria Clinic PA Current Accepting new patients
Douglas County Hospital Current Accepting new patients
West Central Pathology and Laboratory Medicine PA Current Accepting new patients
Douglas County Hospital Internal Medicine Current Accepting new patients
Douglas County Hospital Past Accepting new patients

Locations

111 17th Ave E
Alexandria, MN 56308
Phone (320) 762-1511

610 30th Ave W
Alexandria, MN 56308
Phone (320) 763-2540

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/glac-1755385c
  • Direct secure messaging: jbutanis349397@direct.centracare.com

Organizations & group practices 8

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 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1403222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516665600000",
    "number": "1003220799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 30TH AVENUE WEST",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "56308",
            "telephone_number": "320-763-5123",
            "fax_number": "320-763-7883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 30TH AVE W",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563083426",
            "telephone_number": "320-763-5123",
            "fax_number": "320-763-7883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTANIS",
        "first_name": "JESSICA",
        "middle_name": "M",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-20",
        "last_updated": "2018-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "61656",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "R10068",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "H400413191",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003220799",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "PETERSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Alexandria, MN

Sources for this page

Verify at the official NPI Registry.