Jon Richard Van Der Hagen, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

29424 Issued in MN

Practice address

523 N 3Rd St
Brainerd, MN 56401-3054

Phone

(218) 829-2861

NPI assigned

Mar 9, 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 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• St. Francis Medical Center

  • Critical Access Hospital
  • Breckenridge, MN
  • NPI 1891954574
  NPD (past)
• St Francis Medical Center

  • Rural Health Clinic/Center
  • Milnor, ND
  • NPI 1235215252
  NPD (past)

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452816000000",
    "number": "1326016171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 N 3RD ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564013054",
            "telephone_number": "218-829-2861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "523 N 3RD ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564013054",
            "telephone_number": "218-829-2861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DER HAGEN",
        "first_name": "JON",
        "middle_name": "RICHARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2016-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "29424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "817882800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Becky Twamley
• Audrey Jean Twit, PHARMD
• Nicolle Marie Uban, PHD, APRN, CNM
• Jenna Bergin Ude, D.D.S.
• Valhalla Place Brainerd LLC
• Alexa Vanalst
• Dannia Lor Vang, PHARMD
• John Vanmoer
• Jayme Nicole Vanrisseghem, PHARMD
• Frank Vasey, MD

• Family Medicine Physician in Brainerd, MN
• Providers in Brainerd, 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 Jan 15, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.