NPIMap

Organization Active NPI

Rejuv Medical, P.a.

  • Medical Specialty Clinic/Center
  • Waite Park, MN
National Provider Identifier
1033355086
Registry record updated Jan 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
43368 Issued in MN
Legal business name
REJUV MEDICAL, P.A.
Practice address
901 3Rd St N
Waite Park, MN 56387-1964
Phone
(321) 217-8480
Fax
(320) 217-8490
NPI assigned
Dec 22, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2020

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

Authorized official

Name
Dr. Joel J Baumgartner, M.DNPI 1184679607
Title
Owner
Phone
(320) 217-8480

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 43368 MN Primary

Addresses

Primary practice location

901 3Rd St N
Waite Park, MN 56387-1964

Mailing address

901 3Rd St N
Waite Park, MN 56387-1964
Phone (321) 217-8480

Other identifiers 2

IdentifierTypeStateIssuer
080012605MedicaidMN
64886800OtherMNDMERC SUPPLIER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090303000526 MN Part B Supplier - Clinic/Group Practice 2264598077 Receives reassigned benefits from 16 practitioners
Practice locations: Waite Park, MN
O20110311000126 MN DME Supplier - Physician - Family PracticeDME Supplier - Sports MedicineDME Supplier - Nurse PractitionerDME Supplier - Independently-Practicing Physical Therapist 2264598077 Practice locations: Waite Park, MN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Rejuv Medical PA901 3Rd St N, Waite Park, MN 56387-1964(320) 352-8475 Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf Accepts assignmentParticipating since Sep 2, 2008

National Provider Directory

National Provider Directory

Locations

2330 Troop Dr
Unit 105A
Sartell, MN 56377
Phone (320) 217-8480

901 3rd St N
Waite Park, MN 56387
Phone (320) 217-8480

210 3rd St N
Waite Park, MN 56387
Phone (320) 281-5100

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/32275/brand/1/csg/1/fhir/r4

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1229904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580256000000",
    "number": "1033355086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 3RD ST N",
            "city": "WAITE PARK",
            "state": "MN",
            "postal_code": "563871964",
            "telephone_number": "321-217-8480",
            "fax_number": "320-217-8490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 3RD ST N",
            "city": "WAITE PARK",
            "state": "MN",
            "postal_code": "563871964",
            "telephone_number": "321-217-8480",
            "fax_number": "320-217-8490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REJUV MEDICAL, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-22",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A",
        "authorized_official_last_name": "BAUMGARTNER",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "320-217-8480",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MN",
            "license": "43368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "080012605",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC SUPPLIER NUMBER",
            "identifier": "64886800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waite Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.