Individual provider Active NPI

Jerry M Obritsch, MD

  • Obstetrics & Gynecology Physician
  • Bismarck, ND
National Provider Identifier
1093769291
Registry record updated Jun 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
5899 Issued in ND
Practice address
1000 E Rosser Ave
Bismarck, ND 58501-4414
Phone
(701) 712-4500
Fax
(701) 712-4098
NPI assigned
May 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 5899 ND Primary

Addresses

Primary practice location

1000 E Rosser Ave
Bismarck, ND 58501-4414

Mailing address

1000 E Rosser Ave
Bismarck, ND 58501-4414
Phone (701) 712-4500

Other identifiers 2

IdentifierTypeStateIssuer
16790MedicaidND
160018356OtherNDMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, SD2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20101207000164 ND Practitioner - Obstetrics/Gynecology 7719902170 Reassigns benefits to 2 organizations
I20200820001864 SD Practitioner - Obstetrics/Gynecology 7719902170 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5899NDMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mid Dakota Clinic, Inc. CurrentSince Aug 12, 1991 Accepting new patients
Mobridge Regional Hospital CurrentSince Jul 27, 2020 Accepting new patients
Mobridge Regional Hospital CurrentSince Jul 27, 2020 Accepting new patients
Mobridge Regional Hospital CurrentSince Dec 1, 2025 Accepting new patients
Mobridge Regional Hospital Current Accepting new patients
St Alexius Medical Center CurrentSince Oct 1, 2010 Accepting new patients
St. Alexius Medical Center CurrentSince Oct 1, 2010 Accepting new patients
Fort Yates Indian Health Service Hospital Past Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

900 E Broadway Ave
Bismarck, ND 58501
Phone (701) 530-7300

1000 E Rosser Ave
Bismarck, ND 58501
Phone (701) 530-6000

401 N 9th St
Bismarck, ND 58501
Phone (701) 530-6000

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000

1309 10th Ave W
Mobridge, SD 57601
Phone (605) 845-3692

1401 10th Ave W
Mobridge, SD 57601
Phone (605) 845-3692

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/95143858-4077-4cf1-b5d2-c2a999f62bb3/

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.

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1093769291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E ROSSER AVE",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585014414",
            "telephone_number": "701-712-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E ROSSER AVE",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585014414",
            "telephone_number": "701-712-4500",
            "fax_number": "701-712-4098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OBRITSCH",
        "first_name": "JERRY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "ND",
            "license": "5899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16790",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "160018356",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bismarck, ND

Sources for this page

Verify at the official NPI Registry.