Craig A Vickstrom, M.D

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301086855 Issued in MI

Practice address

3605 Mayfair Ave
Hibbing, MN 55746-2935

Phone

(218) 262-3441

Fax

(906) 524-5126

NPI assigned

Aug 30, 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 identifiers 4

Medicare fee-for-service enrollment

Enrolled in MI

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

Emergency Medicine

Education

University of Iowa, RJ & L Carver College of Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Baraga County Memorial HospitalGroup PAC ID 7416866611, shared by 6 NPIs, 17 clinicians

Aspirus KeweenawGroup PAC ID 8123912011, shared by 7 NPIs, 116 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baraga County Home Care and Hospice Home health agency, L'Anse, MI, CCN 237420
• Baraga County Home Care & Hospice Hospice, L' Anse, MI, CCN 231586
• Baraga County Memorial Hospital Hospital, L' Anse, MI, CCN 231307
• Bayside Village Nursing home, L' Anse, MI, CCN 235144

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 and National Provider Directory roles.

• Baraga County Memorial Hospital

  • Critical Access Hospital
  • Lanse, MI
  • NPI 1558479824
  Medicare reassignment NPD
• Baraga County Memorial Hospital

  • Family Medicine Physician
  • Lanse, MI
  • NPI 1851409643
  Medicare reassignment NPD
• Baraga County Memorial Hospital

  • Emergency Medicine Physician
  • Lanse, MI
  • NPI 1508960600
  NPD
• Baraga County Memorial Hospital

  • Home Health Agency
  • Lanse, MI
  • NPI 1932218807
  NPD
• Baraga County Extended Care Corporation

  • Skilled Nursing Facility
  • Lanse, MI
  • NPI 1629187521
  NPD (past)

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

• Baraga County Extended Care Corporation

  • Skilled Nursing Facility
  • Lanse, MI
  • NPI 1629187521

  Nursing home

  Care Compare affiliation
• Baraga County Memorial Hospital

  • Community Based Hospice Care Agency
  • Lanse, MI
  • NPI 1457459059
  Care Compare affiliation
• Baraga County Memorial Hospital

  • Critical Access Hospital
  • Lanse, MI
  • NPI 1558479824
  Care Compare affiliation
• Baraga County Memorial Hospital

  • Home Health Agency
  • Lanse, MI
  • NPI 1932218807
  Care Compare affiliation

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379030400000",
    "number": "1265541486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3605 MAYFAIR AVE",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557462935",
            "telephone_number": "218-262-3441",
            "fax_number": "906-524-5126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3605 MAYFAIR AVE",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557462935",
            "telephone_number": "218-262-3441",
            "fax_number": "906-524-5126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKSTROM",
        "first_name": "CRAIG",
        "middle_name": "A",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2013-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301086855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4795539",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS - OFFICE",
            "identifier": "080Z710040 CV086855",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS - ER SERVICES",
            "identifier": "010Z760020 CV086855",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4797112",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Hibbing, MN
• Providers in Hibbing, 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 Sep 13, 2013; 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.