NPIMap

Organization Active NPI

David C. Anderholm, MD, PA

  • Psychiatry Physician
  • Baxter, MN
National Provider Identifier
1083725147
Registry record updated Mar 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
DAVID C. ANDERHOLM, MD, PA
Practice address
7115 Forthun Rd
Suite 105
Baxter, MN 56425-8597
Phone
(218) 454-0090
Fax
(218) 454-0091
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2023

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

Authorized official

Name
Elliot Richelson, M.D.
Title
Director, President, Secretary, and
Phone
(904) 605-4986

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

7115 Forthun Rd
Suite 105
Baxter, MN 56425-8597

Mailing address

7115 Forthun Rd
Suite 105
Baxter, MN 56425-8597
Phone (218) 454-0090

Other identifiers 2

IdentifierTypeStateIssuer
503580500MedicaidMN
55A48ANOtherMNBCBS

Other names 1

  • Northern Psychiatric Associates Doing business as

National Provider Directory

National Provider Directory

Locations

804 Wright St
Brainerd, MN 56401
Phone (218) 522-8288

900 Eastwood Ln S
Motley, MN 56466
Phone (218) 352-6941

418 Jefferson Ave
Pine River, MN 56474
Phone (218) 587-4423

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678838400000",
    "number": "1083725147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7115 FORTHUN RD",
            "address_2": "SUITE 105",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258597",
            "telephone_number": "218-454-0090",
            "fax_number": "218-454-0091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7115 FORTHUN RD",
            "address_2": "SUITE 105",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564258597",
            "telephone_number": "218-454-0090",
            "fax_number": "218-454-0091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID C. ANDERHOLM, MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "status": "A",
        "authorized_official_last_name": "RICHELSON",
        "authorized_official_first_name": "ELLIOT",
        "authorized_official_title_or_position": "DIRECTOR, PRESIDENT, SECRETARY, AND",
        "authorized_official_telephone_number": "904-605-4986",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "503580500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "55A48AN",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Psychiatric Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northern Psychiatric Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baxter, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; 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.