Active NPI
Michael Bogenreif, L/ATC
- Athletic Trainer
- Moorhead, MN
National Provider Identifier
1194787242
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 30305
- Practice address
- 3001 22ND St. S.
Moorhead, MN 56560 - Phone
- (701) 899-1108
- NPI assigned
- Apr 4, 2006
- Last updated
- Aug 23, 2014
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 30305 | ND | Primary |
Addresses
Primary practice location
3001 22ND St. S.
Moorhead, MN 56560
Mailing address
3001 22ND St. South
Moorhead, MN 56560
Phone (701) 899-1108
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 450226909 | Other | ND | SANFORD HEALTH |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30305 | ND | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408752000000",
"number": "1194787242",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3001 22ND ST. SOUTH",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "56560",
"telephone_number": "701-899-1108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 22ND ST. S.",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "56560",
"telephone_number": "701-899-1108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOGENREIF",
"first_name": "MICHAEL",
"credential": "L/ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-04",
"last_updated": "2014-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "ND",
"license": "30305",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SANFORD HEALTH",
"identifier": "450226909",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moorhead, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.