Active NPI
Gregory S Anderson, D.O
- General Practice Physician
- Red Lake, MN
National Provider Identifier
1033140561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 32831
- Practice address
- Hwy 1 Hospital Drive
Box 497
Red Lake, MN 56671-0497 - Phone
- (218) 679-3912
- Fax
- (218) 679-0181
- NPI assigned
- Jul 5, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 32831 | MN | Primary |
Addresses
Primary practice location
Hwy 1 Hospital Drive
Box 497
Red Lake, MN 56671-0497
Mailing address
PO Box 497
Redlake, MN 56671-0497
Phone (218) 679-3912
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34G00AN | Other | MN | BC/BS OF MN |
| 476753500 | Medicaid | MN |
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)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32831 | MN | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203552000000",
"number": "1033140561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 497",
"city": "REDLAKE",
"state": "MN",
"postal_code": "566710497",
"telephone_number": "218-679-3912",
"fax_number": "218-679-0181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "HWY 1 HOSPITAL DRIVE",
"address_2": "BOX 497",
"city": "RED LAKE",
"state": "MN",
"postal_code": "566710497",
"telephone_number": "218-679-3912",
"fax_number": "218-679-0181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "GREGORY",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "D.O",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-05",
"last_updated": "2008-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MN",
"license": "32831",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS OF MN",
"identifier": "34G00AN",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "476753500",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Red Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 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.