William J Brunsman, MD
Individual provider Active NPI Family Medicine Physician · Williston, ND
NPI 1104914530 · NPPES record last updated Nov 6, 2021
Key facts
- NPI
- 1104914530
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 10067 (ND)
- Practice address
- 1102 Main
Williston, ND 58801 - Phone
- (701) 572-7711
- Fax
- (701) 572-2283
- NPI assigned
- Oct 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Nebraska College of Medicine, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southern California Permanente Medical Group
Practice addresses (Care Compare)
14011 Park Ave
Victorville, CA 92392-2413
Phone (888) 750-0036
9961 Sierra Ave
Fontana, CA 92335-6720
Phone (909) 427-5000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121112000588 | CA | Practitioner - Family Practice | 2567497290 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Permanente Medical Group | Current | Accepting new patients | |
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Frances Mahon Deaconess Hospital | Past | Accepting new patients |
Locations
9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910
393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 10067 | ND | Yes |
Addresses
Primary practice location
1102 Main
Williston, ND 58801
Mailing address
1102 Main
Williston, ND 58801
Phone (701) 572-7711
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13601 | Medicaid | ND |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) | Southern California Permanente Medical Group |
Other providers in Williston, ND
- Tamrin Brenno-Fagerland
- Danielle J Brenno-Watterud
- Tammie Brock
- Deborah L Bronson
- Brook McFarlin Chiropractic LLC
- Nicole Bryant
- Mandy J Buick
- Buntrock Detnal PC
- Kaitlyn Burch
- Kezzy Burth-Hutchinson
All providers in Williston, ND · Family Medicine Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 6, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.