Eugene John Fortman

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

07746 Issued in MN

Practice address

1010 4TH St SW Ste 300
Mason City, IA 50401-2856

Phone

(641) 424-0301

Fax

(641) 424-0301

NPI assigned

Nov 21, 2006

Last updated

Mar 17, 2018By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Sep 26, 2017 through Sep 26, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1073688792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2533 HAWK HILL LN. SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "55902",
            "telephone_number": "507-288-1073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 4TH ST SW STE 300",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504012856",
            "telephone_number": "641-424-0301",
            "fax_number": "641-424-0301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2112 Viking Dr NW",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "559013522",
            "country_code": "US",
            "telephone_number": "507-288-1338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORTMAN",
        "first_name": "EUGENE",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MN",
            "license": "07746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John F Fitzgerald, CRNA
• Ashley Fjeldheim, NP
• Thomas E Flaherty, LMHC LMSW
• Linda G Floden, MD
• Thomas A Floden, D.D.S.
• Four Oaks Family and Children's Services
• Four Oaks Family and Children's Services
• Diane S Frakes-Julius, PA
• Melissa A Frame, MD
• Francis Lauer Youth Services

• Periodontics in Mason City, IA
• Providers in Mason City, IA by specialty
• Periodontics in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.