NPIMap

Individual provider Active NPI

James E Surdy, M.D.

  • Specialist
  • Hallock, MN
National Provider Identifier
1083705206
Registry record updated Jan 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
33831 Issued in MN
Practice address
1010 S Birch Ave
Hallock, MN 56728-4215
Phone
(218) 843-2165
Fax
(218) 843-8879
NPI assigned
Sep 27, 2006
Last updated
Jan 15, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 33831 MN Primary

Addresses

Primary practice location

1010 S Birch Ave
Hallock, MN 56728-4215

Mailing address

1010 S Birch Ave
Hallock, MN 56728-4215
Phone (218) 843-2165

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
I20041007000153 MN Practitioner - Internal Medicine 4688633449 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Minnesota Medical School, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1010 S Birch Ave
Hallock, MN 56728-4215
Phone (218) 843-3612

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Kittson Memorial Hospital Association CurrentSince Apr 1, 2011 Accepting new patients
Kittson Memorial Hospital Association CurrentSince Apr 1, 2011 Accepting new patients
Kittson Memorial Hospital Association Past Accepting new patients
Lakeside Medical Center, Inc. Past Accepting new patients
McAllen Rutz Eye Clinic PA PastSince Apr 1, 2011 Accepting new patients
Karlstad Healthcare Center, Inc Past Accepting new patients

Locations

1010 S Birch Ave
Hallock, MN 56728
Phone (218) 843-3612

205 Roosevelt Ave W
Karlstad, MN 56732
Phone (218) 436-2251

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Karlstad Healthcare Center, IncKarlstad, MN, CCN 245468B Skilled nursing facility W-2 Managing Employee Apr 1, 2024
Kittson Memorial Hospital AssociationHallock, MN, CCN 245247 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Nov 1, 2016
Nov 1, 2020

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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.

Hospital & facility affiliations 11

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": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358208000000",
    "number": "1083705206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 S BIRCH AVE",
            "city": "HALLOCK",
            "state": "MN",
            "postal_code": "567284215",
            "telephone_number": "218-843-2165",
            "fax_number": "218-843-8879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 S BIRCH AVE",
            "city": "HALLOCK",
            "state": "MN",
            "postal_code": "567284215",
            "telephone_number": "218-843-2165",
            "fax_number": "218-843-8879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURDY",
        "first_name": "JAMES",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2013-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MN",
            "license": "33831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hallock, MN

Sources for this page

Verify at the official NPI Registry.