NPIMap

Individual provider Active NPI

Andrew Moen, D.P.M.

  • Podiatrist
  • Detroit Lakes, MN
National Provider Identifier
1073843587
Registry record updated Dec 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
844 Issued in MN
Practice address
1027 Washington Ave
Detroit Lakes, MN 56501-3409
Phone
(218) 847-5611
Fax
(218) 847-0881
NPI assigned
Jan 5, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X TP-169 MN
Podiatrist 213E00000X 844 MN Primary

Addresses

Primary practice location

1027 Washington Ave
Detroit Lakes, MN 56501-3409

Mailing address

1027 Washington Ave
Detroit Lakes, MN 56501-3409
Phone (218) 847-5611

Other identifiers 1

IdentifierTypeStateIssuer
1073843587MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110713000546 MN Practitioner - Podiatry 4486822665 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Regional Health CenterGroup PAC ID 2062326820, 190 clinicians

Practice addresses (Care Compare)

1027 Washington Ave
Detroit Lakes, MN 56501-3409
Phone (218) 844-2300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue27
Removal of nail tissue18
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TP-169MNMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
First Care Medical Services CurrentSince Aug 1, 2011 Accepting new patients
First Care Medical Services Current Accepting new patients
First Care Medical Services CurrentSince Aug 1, 2011 Accepting new patients
St. Mary'S Regional Health Center CurrentSince Jun 17, 2011 Accepting new patients
St. Marys Regional Health Center Current Accepting new patients
Bridges Medical Center CurrentSince Apr 13, 2022 Accepting new patients
St Mary'S Regional Health Center CurrentSince Jun 17, 2011 Accepting new patients
Bridges Medical Center CurrentSince Jan 1, 2026 Accepting new patients
St Marys Regional Health Center Past Accepting new patients

Locations

201 9th St W
Ada, MN 56510
Phone (218) 784-2727

1027 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 844-2300

900 Hilligoss Blvd SE
Fosston, MN 56542
Phone (218) 435-1133

1103 1st St E
Park Rapids, MN 56470
Phone (218) 732-0542

301 N Broadway
Pelican Rapids, MN 56572
Phone (218) 863-2000

Organizations & group practices 9

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1262649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323216000000",
    "number": "1073843587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 WASHINGTON AVE",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013409",
            "telephone_number": "218-847-5611",
            "fax_number": "218-847-0881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 WASHINGTON AVE",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013409",
            "telephone_number": "218-847-5611",
            "fax_number": "218-847-0881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOEN",
        "first_name": "ANDREW",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-05",
        "last_updated": "2011-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MN",
            "license": "TP-169",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MN",
            "license": "844",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073843587",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit Lakes, MN

Sources for this page

Verify at the official NPI Registry.