Prasad Munusamy, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

75609 Issued in MN

Practice address

711 Delmore Dr
Roseau, MN 56751

Phone

(218) 463-1365

Fax

(843) 839-2382

NPI assigned

Apr 29, 2021

Last updated

Jun 17, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Family Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Altru Health SystemGroup PAC ID 1355251604, 675 clinicians

Lifecare Medical CenterGroup PAC ID 4789586884, 55 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lifecare Hospice Hospice, Roseau, MN, CCN 241563
• Lifecare Medical Center Hospital, Roseau, MN, CCN 241344
• Altru Hospital Hospital, Grand Forks, ND, CCN 350019
• Lifecare Medical Center Nursing home, CCN 24Z344
• Warroad Care Center Nursing home, Warroad, MN, CCN 245329

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Altru Health System

  dba Altru Clinic Crookston

  • Clinic/Center
  • Crookston, MN
  • NPI 1760494330
  Medicare reassignment Care Compare group NPD
• Lifecare Medical Center

  • Critical Access Hospital
  • Roseau, MN
  • NPI 1609861095
  Medicare reassignment Care Compare group NPD
• Altru Health System

  dba Altru Clinic - Roseau

  • Rural Health Clinic/Center
  • Roseau, MN
  • NPI 1770672289
  NPD
• Lifecare Medical Center

  dba Lifecare Clinic Warroad

  • Rural Health Clinic/Center
  • Warroad, MN
  • NPI 1619724077
  NPD
• Altru Health System

  dba Altru Care Flight

  • Ambulance
  • Grand Forks, ND
  • NPI 1114485315
  NPD

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

• Lifecare Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Roseau, MN
  • NPI 1235268350

  Nursing home

  Care Compare affiliation
• Lifecare Medical Center

  • Critical Access Hospital
  • Roseau, MN
  • NPI 1609861095
  Care Compare affiliation
• Lifecare Medical Center

  • Community Based Hospice Care Agency
  • Roseau, MN
  • NPI 1760478929
  Care Compare affiliation
• Warroad Care Center, Inc.

  • Skilled Nursing Facility
  • Warroad, MN
  • NPI 1811997489

  Nursing home

  Care Compare affiliation
• Altru Health System

  • General Acute Care Hospital
  • Grand Forks, ND
  • NPI 1154346161
  Care Compare affiliation

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

{
    "created_epoch": "1619654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1235712043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13780",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58208",
            "telephone_number": "843-848-4640",
            "fax_number": "843-839-2382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 DELMORE DR",
            "city": "ROSEAU",
            "state": "MN",
            "postal_code": "56751",
            "telephone_number": "218-463-1365",
            "fax_number": "843-839-2382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNUSAMY",
        "first_name": "PRASAD",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-29",
        "last_updated": "2024-06-17",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "75609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jack Victor Lundbohm
• Renae J Matthews, PA-C
• Mattson Pharmacy, Inc
• Kayla Marie McLaughlin, RN
• Mind Body Health & Wellness PA
• Erin Murray
• Randy Ray Olson, P.T.
• Ross Olson
• Samantha Jo Olson, CNP
• Jessica Lin Omdahl, APRN, PMHNP-BC

• Family Medicine Physician in Roseau, MN
• Providers in Roseau, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; 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.