Individual provider Active NPI

Robert William Beattie, M.D

  • Family Medicine Physician
  • East Grand Forks, MN
National Provider Identifier
1215957402
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
3623 Issued in SD
Practice address
621 Demers Ave
East Grand Forks, MN 56721-1833
Phone
(218) 773-5800
NPI assigned
Jul 20, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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 5931 ND
Family Medicine Physician 207Q00000X 3623 SD Primary

Addresses

Primary practice location

621 Demers Ave
East Grand Forks, MN 56721-1833

Mailing address

401 Desiree Dr
Grand Forks, ND 58201-2924
Phone (701) 775-7296

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
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
5931NDMDFamily Medicine Physician
3623SDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Yates Indian Health Service Hospital 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1215957402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 DESIREE DR",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582012924",
            "telephone_number": "701-775-7296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 DEMERS AVE",
            "city": "EAST GRAND FORKS",
            "state": "MN",
            "postal_code": "567211833",
            "telephone_number": "218-773-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEATTIE",
        "first_name": "ROBERT",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "5931",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "3623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Grand Forks, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.