Individual provider Active NPI

Mark Engelsgjerd, M.D.

  • Surgery Physician
  • Saint Cloud, MN
National Provider Identifier
1063442622
Registry record updated Nov 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
39768 Issued in MN
Practice address
251 County Rd 120
Saint Cloud, MN 56303-4665
Phone
(320) 202-8949
Fax
(320) 202-0756
NPI assigned
Jul 3, 2006
Last updated
Nov 26, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 39768 MN Primary

Addresses

Primary practice location

251 County Rd 120
Saint Cloud, MN 56303-4665

Mailing address

251 County Rd 120
Saint Cloud, MN 56303-4665
Phone (320) 202-8949

Other identifiers 1

IdentifierTypeStateIssuer
775318700MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100616000769 MN Practitioner - General Surgery 3971584616 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
39768MNMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic Past Accepting new patients
Centracare Clinic Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mengelsgjerd1265@direct.centracare.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290729600000",
    "number": "1063442622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 COUNTY RD 120",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563034665",
            "telephone_number": "320-202-8949",
            "fax_number": "320-202-0756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 COUNTY RD 120",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563034665",
            "telephone_number": "320-202-8949",
            "fax_number": "320-202-0756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENGELSGJERD",
        "first_name": "MARK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2010-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MN",
            "license": "39768",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "775318700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.