Individual provider Active NPI

James Baumgartner, MD

  • Internal Medicine Physician
  • Waite Park, MN
National Provider Identifier
1073577540
Registry record updated Jan 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
21313 Issued in MN
Practice address
901 3Rd St N
Waite Park, MN 56387-1964
Phone
(320) 217-8480
Fax
(320) 217-8490
NPI assigned
Apr 13, 2006
Last updated
Jan 29, 2020By the provider in NPPES
Sex
Male
Sole proprietor
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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 21313 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 (320) 352-8475

Other identifiers 1

IdentifierTypeStateIssuer
1073577540MedicaidMN

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 Medicine

State licenses

LicenseStateTypeSpecialty
4772NDMDSocial Worker
21313MNMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580256000000",
    "number": "1073577540",
    "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": "320-352-8475",
            "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": "320-217-8480",
            "fax_number": "320-217-8490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUMGARTNER",
        "first_name": "JAMES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-13",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "21313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073577540",
            "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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.