Custom Medical Equipment LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

9615269 Issued in MN

Legal business name

CUSTOM MEDICAL EQUIPMENT LLC

Practice address

1001 S Pokegama Ave Ste a
Grand Rapids, MN 55744-3919

Phone

(218) 326-2212

NPI assigned

Aug 20, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Josephine Lyn Czerny, CRTS

Title

Owner

Phone

(218) 326-2212

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1219190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660867200000",
    "number": "1306093463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 S POKEGAMA AVE STE A",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443919",
            "telephone_number": "218-326-2212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 S POKEGAMA AVE STE A",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443919",
            "telephone_number": "218-326-2212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM MEDICAL EQUIPMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-20",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-19",
        "status": "A",
        "authorized_official_last_name": "CZERNY",
        "authorized_official_first_name": "JOSEPHINE",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-326-2212",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CRTS"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "MN",
            "license": "9615269",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "697697100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• County of Itasca
• Leah Nicole Crossley, LADC
• Amy Cummings, RN
• Lindsay Ryann Curtiss
• Patrice Marie Curtiss
• Heidi Dahlberg, OD
• Geoffrey Daigle
• Darwin Dalen, O.D.
• Noel Elizabeth Danielson, DNP
• Darla & Rob Rima

• Customized Equipment (DME) in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• Customized Equipment (DME) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.