Active NPI
Robert Fernandez, MD
- Surgery Physician
- Fairmont, MN
National Provider Identifier
1114904869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 38613
- Practice address
- 800 Medical Center Dr
Fairmont, MN 56031-4575 - Phone
- (507) 238-8555
- NPI assigned
- Dec 23, 2005
- Last updated
- Jul 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 38613 | MN | Primary |
Addresses
Primary practice location
800 Medical Center Dr
Fairmont, MN 56031-4575
Mailing address
800 Medical Center Dr
PO Box 800
Fairmont, MN 56031-4575
Phone (507) 238-8555
Other identifiers 12
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00T97FE | Medicaid | MN | |
| 7424 | Other | MN | AVERA |
| 89026000 | Medicaid | MN | |
| HP30144 | Other | MN | HEALTHPARTNERS |
| 17-01033 | Other | MN | MEDICA |
| MH9041010113 | Other | MN | PREFERREDONE |
| 976373 | Medicaid | IA | |
| 00T97FE | Other | MN | BLUE CROSS |
| 120141 | Medicaid | MN | |
| 705220 | Other | MN | ARAZ |
| 22694 | Other | MN | SIOUX VALLEY |
| A022 | Other | MN | CHAMPUS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38613 | MN | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1114904869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 MEDICAL CENTER DR",
"address_2": "PO BOX 800",
"city": "FAIRMONT",
"state": "MN",
"postal_code": "560314575",
"telephone_number": "507-238-8555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 MEDICAL CENTER DR",
"city": "FAIRMONT",
"state": "MN",
"postal_code": "560314575",
"telephone_number": "507-238-8555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERNANDEZ",
"first_name": "ROBERT",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-23",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MN",
"license": "38613",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00T97FE",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AVERA",
"identifier": "7424",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89026000",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP30144",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "17-01033",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERREDONE",
"identifier": "MH9041010113",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "976373",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "00T97FE",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "120141",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARAZ",
"identifier": "705220",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SIOUX VALLEY",
"identifier": "22694",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "A022",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairmont, MN
- Fairmont Family Dentistry, PA
- Fairmont Orthopedics & Sports Medicine P a (Center for Specialty Care)
- Fairmont Orthopedics & Sports Medicine, PA (Center for Specialty Care)
- Fairmont Orthopedics & Sports Medicine, PA (Center for Specialty Care)
- Samantha Augusta Farnum, APRN
- Five Lakes Dental Studio LLC
- Daniel Jeffrey Fordice, D.M.D.
- Jeffrey Howard Fordice, DDS
- Taylor Forstner, DDS
- Amanda J Forstrom, PT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.