Active NPI
Tom Debrito, CRNA
- Specialist
- Fergus Falls, MN
National Provider Identifier
1043248784
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 31061
- Practice address
- 712 S Cascade St
Fergus Falls, MN 56537-2913 - Phone
- (218) 736-8000
- NPI assigned
- Jun 29, 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 31061 | MN | Primary |
Addresses
Primary practice location
712 S Cascade St
Fergus Falls, MN 56537-2913
Mailing address
712 S Cascade St
Fergus Falls, MN 56537-2913
Phone (218) 736-8000
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
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31061 | MN | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake Region Healthcare Corporation | Current | Accepting new patients |
Locations
712 S Cascade St
Fergus Falls, MN 56537
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/e35355ac-dfca-48b9-9dd9-0b7c408c2a66/
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Fergus Falls, MN
- NPI 1093713372
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043248784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "712 S CASCADE ST",
"city": "FERGUS FALLS",
"state": "MN",
"postal_code": "565372913",
"telephone_number": "218-736-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "712 S CASCADE ST",
"city": "FERGUS FALLS",
"state": "MN",
"postal_code": "565372913",
"telephone_number": "218-736-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEBRITO",
"first_name": "TOM",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MN",
"license": "31061",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fergus Falls, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.