Allan James Luistro, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

37656 Issued in MN

Practice address

1104 7TH Ave S.
Box 92 Msum Hendrix Clinic & Counseling Center
Moorhead, MN 56563

Phone

(218) 477-2211

Fax

(218) 477-5867

NPI assigned

Feb 21, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• The Swanson Foundation

  • Medical Specialty Clinic/Center
  • Fargo, ND
  • NPI 1346914033

  ND

  Medicare reassignment NPD
• Family Health Care Center

  • Federally Qualified Health Center (FQHC)
  • Moorhead, MN
  • NPI 1982162434
  NPD (past)
• Hendrix Health Center Pharmacy

  • Pharmacist
  • Moorhead, MN
  • NPI 1326176439
  NPD (past)

Specialty

Family Practice

Education

University of North Dakota School of Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329868800000",
    "number": "1073648259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5027 ROSE CREEK PKWY S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581046848",
            "telephone_number": "701-298-9024",
            "fax_number": "701-297-0132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 7TH AVE S.",
            "address_2": "BOX 92 MSUM HENDRIX CLINIC & COUNSELING CENTER",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "56563",
            "telephone_number": "218-477-2211",
            "fax_number": "218-477-5867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUISTRO",
        "first_name": "ALLAN",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-21",
        "last_updated": "2012-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "37656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "804733200",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17256",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lost & Found Recovery Center
• David Lotzer, D.C.
• Jeffrey Lotzer, D.C.
• Michele Louise Lovehaug, LICSW
• Rachelle Lucien
• Megan Lundborg, LGSW, LMSW
• Sydney Lundebrek
• Karin M Lundquist
• Dawn Lundstrom
• Lutheran Social Service of Minnesota

• All providers in Moorhead, MN
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.