NPIMap

Individual provider Active NPI

Mark David Bostrom, MD

  • Family Medicine Physician
  • New Richmond, WI
National Provider Identifier
1255860169
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
73969 Issued in WI
Practice address
535 Hospital Rd
New Richmond, WI 54017-1449
Phone
(715) 243-2600
NPI assigned
Jun 6, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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 64340 MN
Family Medicine Physician 207Q00000X 73969 WI Primary

Addresses

Primary practice location

535 Hospital Rd
New Richmond, WI 54017-1449

Mailing address

8170 33Rd Ave S
Bloomington, MN 55425-4516

Other practice location 1

330 N 8th Ave E
Duluth, MN 55805-2024
Phone (218) 723-1112

Other practice location 2

640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 439-1234

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 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
I20201101000006 WI Practitioner - Family Practice 2466886361 Reassigns benefits to 2 organizations
I20210211002877 MN Practitioner - Family PracticePractitioner - Hospitalist 2466886361 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Westfields Hospital IncGroup PAC ID 2264490960, 108 clinicians

Practice addresses (Care Compare)

535 Hospital Rd
New Richmond, WI 54017-1449
Phone (715) 243-2600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.67 of 100Reported as individual
Quality
92.12
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
73969WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Westfields Hospital, Inc CurrentSince Oct 12, 2020 Accepting new patients
Group Health, Inc. CurrentSince Feb 1, 2021 Accepting new patients
Group Health, Inc. Current Accepting new patients
Westfields Hospital, Inc. Family Medicine CurrentSince Oct 12, 2020 Accepting new patients
Group Health, Inc. CurrentSince Feb 1, 2021 Accepting new patients
Westfields Hospital, Inc. Past Accepting new patients
The Duluth Clinic, LTD. Past Accepting new patients
Duluth Graduate Medical Education Council Inc Family Medicine PastSince Jun 22, 2004 Accepting new patients

Locations

8170 33rd Ave S
Minneapolis, MN 55425
Phone (952) 883-5463

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

535 Hospital Rd
New Richmond, WI 54017
Phone (651) 292-2013

Interoperability endpoints

  • Direct secure messaging: mbostrom215533@direct.healthpartners.com

Organizations & group practices 8

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 11

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": "1496707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1255860169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 HOSPITAL RD",
            "city": "NEW RICHMOND",
            "state": "WI",
            "postal_code": "540171449",
            "telephone_number": "715-243-2600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "330 N 8th Ave E",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558052024",
            "country_code": "US",
            "telephone_number": "218-723-1112",
            "fax_number": "218-725-2620",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "640 Jackson St",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551012502",
            "country_code": "US",
            "telephone_number": "651-439-1234",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOSTROM",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-06",
        "last_updated": "2022-07-21",
        "certification_date": "2021-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "64340",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "73969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Richmond, WI

Sources for this page

Verify at the official NPI Registry.