Active NPI
Heidi Dahlberg, OD
- Optometrist
- Grand Rapids, MN
National Provider Identifier
1124289160
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3129
- Practice address
- 100 SE 29TH St
Grand Rapids, MN 55744-4043 - Phone
- (218) 326-1101
- Fax
- (218) 326-1106
- NPI assigned
- Jun 23, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3129 | MN | Primary |
Addresses
Primary practice location
100 SE 29TH St
Grand Rapids, MN 55744-4043
Mailing address
100 SE 29TH St
Grand Rapids, MN 55744-4043
Phone (218) 326-1101
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081215000440 | MN | Practitioner - Optometry | 5092877738 | Practice locations: Grand Rapids, MN |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Ohio State University - College of Optometry, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
100 SE 29TH St
Grand Rapids, MN 55744-4043
Phone (218) 326-1101
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 18 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3129 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276473600000",
"number": "1124289160",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 SE 29TH ST",
"city": "GRAND RAPIDS",
"state": "MN",
"postal_code": "557444043",
"telephone_number": "218-326-1101",
"fax_number": "218-326-1106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 SE 29TH ST",
"city": "GRAND RAPIDS",
"state": "MN",
"postal_code": "557444043",
"telephone_number": "218-326-1101",
"fax_number": "218-326-1106"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAHLBERG",
"first_name": "HEIDI",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-23",
"last_updated": "2010-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "3129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.