Active NPI
John W Gfrerer, MD
- Family Medicine Physician
- Andover, MN
National Provider Identifier
1316911530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 22852
- Practice address
- 15245 Bluebird St NW
Mail Stop 39200a
Andover, MN 55304-3554 - Phone
- (763) 712-6000
- Fax
- (763) 712-6090
- NPI assigned
- Feb 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 22852 | MN | Primary |
Addresses
Primary practice location
15245 Bluebird St NW
Mail Stop 39200a
Andover, MN 55304-3554
Mailing address
15245 Bluebird St NW
21110Q
Andover, MN 55304-3554
Phone (763) 587-4600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 695587800 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401408000000",
"number": "1316911530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15245 BLUEBIRD ST NW",
"address_2": "21110Q",
"city": "ANDOVER",
"state": "MN",
"postal_code": "553043554",
"telephone_number": "763-587-4600",
"fax_number": "763-587-4615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15245 BLUEBIRD ST NW",
"address_2": "MAIL STOP 39200A",
"city": "ANDOVER",
"state": "MN",
"postal_code": "553043554",
"telephone_number": "763-712-6000",
"fax_number": "763-712-6090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GFRERER",
"first_name": "JOHN",
"middle_name": "W",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-14",
"last_updated": "2014-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "22852",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "695587800",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Andover, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.