NPIMap

Individual provider Active NPI

Jeffrey B Andersen, MD

  • Family Medicine Physician
  • Fargo, ND
National Provider Identifier
1184701856
Registry record updated Dec 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
10297 Issued in ND
Practice address
2400 32ND Ave S
Fargo, ND 58103-5800
Phone
(701) 234-2000
NPI assigned
Nov 1, 2006
Last updated
Dec 23, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 10297 ND Primary
Family Medicine Physician 207Q00000X 52145 MN

Addresses

Primary practice location

2400 32ND Ave S
Fargo, ND 58103-5800

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Other practice location 1

1245 Washington Ave
Detroit Lakes, MN 56501-3905
Phone (218) 846-2000

Other identifiers 2

IdentifierTypeStateIssuer
16455MedicaidND
14023MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070110000116 ND Practitioner - Family Practice 8729088042 Reassigns benefits to 4 organizations
I20111109000729 MN Practitioner - Family Practice 8729088042 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Dakota School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

1220 Sheyenne St
West Fargo, ND 58078-2637
Phone (701) 234-4445

2400 32ND Ave S
Fargo, ND 58103-5800
Phone (701) 234-2000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo Family Medicine CurrentSince Feb 17, 2014 Accepting new patients
Mercy Hospital CurrentSince Jun 28, 2014 Accepting new patients
Perham Hospital District Family Medicine Current Accepting new patients
Mercy Hospital of Valley City Current Accepting new patients
Sanford Medical Center Fargo CurrentSince Feb 17, 2014 Accepting new patients
Lutheran Charity Association Current Accepting new patients
Perham Hospital District CurrentSince Jun 15, 2012 Accepting new patients
Lutheran Charity Association CurrentSince Sep 28, 2015 Accepting new patients
Lutheran Charity Association CurrentSince Sep 28, 2015 Accepting new patients
Perham Hospital District CurrentSince Jun 15, 2012 Accepting new patients
Mahnomen Health Center CurrentSince Oct 27, 2011 Accepting new patients
Mercy Hospital of Valley City CurrentSince Jun 28, 2014 Accepting new patients

Locations

3265 Solutions Ctr
Chicago, IL 60677

1245 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 846-2000

414 W Jefferson Ave
Mahnomen, MN 56557
Phone (218) 935-2511

4000 28th Ave S
Moorhead, MN 56560
Phone (701) 234-3200

105 Otter Dr
Ottertail, MN 56571
Phone (218) 367-6111

211 E Mill St
Pelican Rapids, MN 56572
Phone (218) 863-6100

1000 Coney St W
Perham, MN 56573
Phone (218) 347-1200

401 12th St N
Wheaton, MN 56296
Phone (320) 563-8226

2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800

407 Washington Ave E
Finley, ND 58230
Phone (701) 524-1005

2422 20th St SW
Jamestown, ND 58401
Phone (701) 252-1050

42 6th Ave SE
Mayville, ND 58257
Phone (701) 786-3800

520 Chautauqua Blvd
Valley City, ND 58072
Phone (701) 845-6000

570 Chautauqua Blvd
Valley City, ND 58072
Phone (701) 845-0440

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608681600000",
    "number": "1184701856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 32ND AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581035800",
            "telephone_number": "701-234-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1245 Washington Ave",
            "address_purpose": "LOCATION",
            "city": "Detroit Lakes",
            "state": "MN",
            "postal_code": "565013905",
            "country_code": "US",
            "telephone_number": "218-846-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "JEFFREY",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "10297",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "52145",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16455",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14023",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.