Shelby Rae Bucholz, MD
Individual provider Active NPI Family Medicine Physician · Perham, MN
NPI 1124645064 · NPPES record last updated Jun 20, 2023
Key facts
- NPI
- 1124645064
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 31364 (MN)
- Practice address
- 1000 Coney St W
Perham, MN 56573-2102 - Phone
- (218) 347-1200
- NPI assigned
- Jun 26, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Perham Hospital District
Practice addresses (Care Compare)
1000 Coney St W
Perham, MN 56573-2102
Phone (218) 347-1656
1000 Coney W St
Perham, MN 56573-2102
Hospital & facility affiliations
- Perham Living Home Care
- Perham Health
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.39 of 100
- Quality
- 91.62
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 66.36
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- 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 |
|---|---|---|---|---|
| I20230726002654 | MN | Practitioner - Family Practice | 3072974898 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31364 | MN | MD | Family Medicine Physician |
| NDRL16577 | ND | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Perham Hospital District | Current | Accepting new patients | |
| Perham Hospital District | Family Medicine | Current |
Accepting new patients |
| Perham Hospital District | Current | Accepting new patients | |
| Perham Hospital District | Current |
Accepting new patients | |
| Sanford Clinic North | Family Medicine | Past | Accepting new patients |
Locations
1000 Coney St W
Perham, MN 56573
Phone (218) 347-1200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | NDRL16577 | ND | |
| Family Medicine Physician | 207Q00000X | 31364 | MN | Yes |
Addresses
Primary practice location
1000 Coney St W
Perham, MN 56573-2102
Mailing address
PO Box 5074
Sioux Falls, SD 57117-5074
Other names
- Shelby Rae Hollinger
Other providers in Perham, MN
- Kathryn Boutiette
- Tracey Bovkoon
- Cheryl Lee Braham
- Steven Robert Braukmann
- James Broton
- Samantha Burcham
- Ronald M Burd
- Brooke Busse
- Ivy Callahan
- Wilma Ann Certain
All providers in Perham, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2023. 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.