Douglas Mark Soderberg, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

26672 Issued in MN

Practice address

5415 Queen Ave S
Minneapolis, MN 55410-2530

Phone

(612) 963-1367

Fax

(612) 677-3324

NPI assigned

Mar 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Douglas Mark Soderberg Professional name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Obstetrics/Gynecology

Education

University of Minnesota Medical School, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Centracare Clinic Southwest LLCGroup PAC ID 8426457946, 172 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dsoderberg303834@direct.centracare.com

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.

• Centracare Clinic Southwest LLC

  • Multi-Specialty Clinic/Center
  • Willmar, MN
  • NPI 1174106264
  Medicare reassignment Care Compare group NPD
• Astera Health

  dba Astera Health Wadena Clinic

  • Rural Health Clinic/Center
  • Wadena, MN
  • NPI 1134305162
  Medicare reassignment NPD
• Astera Health

  dba Tri- County Health Care

  • Critical Access Hospital
  • Wadena, MN
  • NPI 1477545333
  Medicare reassignment NPD
• Carris Health LLC

  dba CentraCare - Rice Memorial Hospital

  • Emergency Medicine Physician
  • Willmar, MN
  • NPI 1134632680
  Medicare reassignment NPD
• County of Meeker

  dba Meeker Memorial Hospital & Clinics - East/West

  • Rural Health Clinic/Center
  • Litchfield, MN
  • NPI 1083221816
  Medicare reassignment NPD
• Fairview Health Services

  • Emergency Medicine Physician
  • Minneapolis, MN
  • NPI 1811077175
  Medicare reassignment
• Centracare Clinic Southwest LLC

  • Durable Medical Equipment & Medical Supplies
  • Willmar, MN
  • NPI 1912664889
  NPD
• County of Meeker

  dba Meeker Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Litchfield, MN
  • NPI 1578718482
  NPD
• Fairview Health Services

  dba Fairview Hospital University

  • General Acute Care Hospital
  • Minneapolis, MN
  • NPI 1013994359
  NPD
• Fairview Health Services

  dba Fairview Emergency Medical Services

  • Land Ambulance
  • Saint Paul, MN
  • NPI 1710212485
  NPD
• Fairview Health Services

  • Hospitalist Physician
  • Edina, MN
  • NPI 1770663031
  NPD
• Minnesota Pathologists Chartered

  • Anatomic Pathology & Clinical Pathology Physician
  • Willmar, MN
  • NPI 1992851315
  NPD

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

{
    "created_epoch": "1143244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215997952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5415 QUEEN AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554102530",
            "telephone_number": "612-963-1367",
            "fax_number": "612-677-3324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5415 QUEEN AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554102530",
            "telephone_number": "612-963-1367",
            "fax_number": "612-677-3324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SODERBERG",
        "first_name": "DOUGLAS",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "26672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DOUGLAS",
            "last_name": "SODERBERG",
            "middle_name": "MARK",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Paul A Sobotka, MD
• Cristina Jeanine Sobotta, DOULA
• Lauren Elizabeth Sobotta, LICSW
• Social Working Queer LLC
• Socorro Consulting, LLC
• Matthew Soderberg, MD
• Aubrey Soderlund
• Joseph F Soderlund, MD
• Raymond Charles Soderlund, PA
• Regina Soehnlein

• Obstetrics & Gynecology Physician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Obstetrics & Gynecology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.