NPIMap

Individual provider Active NPI

Erik Bostrom, M.D.

  • Family Medicine Physician
  • Aitkin, MN
National Provider Identifier
1003250655
Registry record updated Oct 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
59333 Issued in MN
Practice address
200 Bunker Hill Dr
Aitkin, MN 56431-1865
Phone
(218) 927-2157
NPI assigned
Apr 25, 2013
Last updated
Oct 23, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 59333 MN Primary

Addresses

Primary practice location

200 Bunker Hill Dr
Aitkin, MN 56431-1865

Mailing address

200 Bunker Hill Dr
Aitkin, MN 56431-1865
Phone (218) 927-2157

Other identifiers 1

IdentifierTypeStateIssuer
1003250655MedicaidMN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ebostrom123274@excellian.direct.allina.com Direct

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
I20160820000171 MN Practitioner - Family Practice 8527366434 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aitkin Community Hospital IncGroup PAC ID 4981514692, 96 clinicians

Practice addresses (Care Compare)

200 Bunker Hill Dr
Aitkin, MN 56431-1865
Phone (218) 927-2157

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
59333MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aitkin Community Hospital, Inc. Current Accepting new patients
Aitkin Community Hospital, Inc. CurrentSince Jul 22, 2016 Accepting new patients
Aitkin Community Hospital, Inc. Current Accepting new patients
Aitkin Community Hospital, Inc. CurrentSince Jul 22, 2016 Accepting new patients
Aitkin Community Hospital, Inc. Current Accepting new patients

Locations

200 Bunker Hill Dr
Aitkin, MN 56431
Phone (218) 927-2121

Interoperability endpoints

  • Direct secure messaging: ebostrom123274@excellian.direct.allina.com
  • Direct secure messaging: ebostrom333861@direct.centracare.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1366848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603411200000",
    "number": "1003250655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 BUNKER HILL DR",
            "city": "AITKIN",
            "state": "MN",
            "postal_code": "564311865",
            "telephone_number": "218-927-2157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BUNKER HILL DR",
            "city": "AITKIN",
            "state": "MN",
            "postal_code": "564311865",
            "telephone_number": "218-927-2157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSTROM",
        "first_name": "ERIK",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-25",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "59333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003250655",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ebostrom123274@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "200 Bunker Hill Dr",
            "city": "Aitkin",
            "state": "MN",
            "country_code": "US",
            "postal_code": "564311865",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Aitkin, MN

Sources for this page

Verify at the official NPI Registry.