Active NPI
Randy Michael Halstrom
- Dentist
- Sartell, MN
National Provider Identifier
1013185883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D7550
- Practice address
- 4572 Pine Point Rd
Sartell, MN 56377-9748 - Phone
- (320) 367-0389
- NPI assigned
- Feb 14, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D7550 | MN | Primary |
Addresses
Primary practice location
4572 Pine Point Rd
Sartell, MN 56377-9748
Mailing address
4572 Pine Point Rd
Sartell, MN 56377-9748
Phone (320) 367-0389
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D7550 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202947200000",
"number": "1013185883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4572 PINE POINT RD",
"city": "SARTELL",
"state": "MN",
"postal_code": "563779748",
"telephone_number": "320-367-0389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4572 PINE POINT RD",
"city": "SARTELL",
"state": "MN",
"postal_code": "563779748",
"telephone_number": "320-367-0389"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALSTROM",
"first_name": "RANDY",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-02-14",
"last_updated": "2008-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D7550",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sartell, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.