Active NPI
Dave McCollum, M.D.
- Emergency Medicine Physician
- Waconia, MN
National Provider Identifier
1154360808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 25697
- Practice address
- 500 S Maple St
Waconia, MN 55387-1752 - Phone
- (952) 442-2191
- NPI assigned
- Jun 6, 2006
- 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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 25697 | MN | Primary |
Addresses
Primary practice location
500 S Maple St
Waconia, MN 55387-1752
Mailing address
PO Box 81
Chaska, MN 55318-0081
Phone (888) 398-3327
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0C319MC | Other | BCBS | |
| 0235010 | Other | PREFERRED ONE | |
| 39-03774 | Other | MEDICA EMERG | |
| 933800400 | Medicaid | MN | |
| HP13930 | Other | HEALTH PARTNERS | |
| 106062 | Other | UCARE |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency Physicians & Consultants, PA | Emergency Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Emergency Medicine Physician
- Waconia, MN
- NPI 1194760009
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196726400000",
"number": "1154360808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 81",
"city": "CHASKA",
"state": "MN",
"postal_code": "553180081",
"telephone_number": "888-398-3327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 S MAPLE ST",
"city": "WACONIA",
"state": "MN",
"postal_code": "553871752",
"telephone_number": "952-442-2191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCOLLUM",
"first_name": "DAVE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-06",
"last_updated": "2007-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MN",
"license": "25697",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0C319MC",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "0235010",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA EMERG",
"identifier": "39-03774",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "933800400",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP13930",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "106062",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Waconia, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.