NPIMap

Individual provider Active NPI

Charles Stephen Shaffer, M.D.

  • Family Medicine Physician
  • Park Rapids, MN
National Provider Identifier
1235450982
Registry record updated Dec 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
60110 Issued in MN
Practice address
110 7TH St W
Park Rapids, MN 56470-1872
Phone
(218) 699-3121
NPI assigned
Jun 17, 2010
Last updated
Dec 11, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2023

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 60110 MN Primary
Hospitalist Physician 208M00000X 60110 MN

Addresses

Primary practice location

110 7TH St W
Park Rapids, MN 56470-1872

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Other practice location 1

1027 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 847-5611

Other identifiers 1

IdentifierTypeStateIssuer
60110OtherMNSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 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
I20170512001873 MN Practitioner - Family PracticePractitioner - Hospitalist 1658674809
I20251215003332 WI Practitioner - Family Practice 1658674809 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Hospitalist
Education
JC Edwards School of Medicine, Marshall University, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Burnett Medical Center IncGroup PAC ID 2163314931, shared by 4 NPIs, 20 clinicians
St. Croix Tribal CouncilGroup PAC ID 1153369350, 7 clinicians

Practice addresses (Care Compare)

257 W Saint George Ave
Grantburg, WI 54840-7827
Phone (715) 463-5353

4404 State Rd
Suite 70
Webster, WI 54893-9251
Phone (715) 349-8554

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.56 of 100Reported as group
Quality
74.25
Promoting interoperability
100
Improvement activities
40
Cost
76.16

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Burnett Medical Center Inc CurrentSince Oct 6, 2025 Accepting new patients
Burnett Medical Center Inc Family Medicine CurrentSince Oct 6, 2025 Accepting new patients
Burnett Medical Center Inc CurrentSince Oct 6, 2025 Accepting new patients
Sanford Health of Northern Minnesota Family Medicine Current Accepting new patients

Locations

1611 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2020

257 W Saint George Ave
Grantsburg, WI 54840
Phone (715) 463-5353

Organizations & group practices 5

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 5

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": "1276732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702252800000",
    "number": "1235450982",
    "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": "110 7TH ST W",
            "city": "PARK RAPIDS",
            "state": "MN",
            "postal_code": "564701872",
            "telephone_number": "218-699-3121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1027 Washington Ave",
            "address_purpose": "LOCATION",
            "city": "Detroit Lakes",
            "state": "MN",
            "postal_code": "56501",
            "country_code": "US",
            "telephone_number": "218-847-5611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "CHARLES",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-17",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "60110",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MN",
            "license": "60110",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "60110",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Rapids, MN

Sources for this page

Verify at the official NPI Registry.