Great Western Medical Group PLLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

53573 Issued in MN

Legal business name

GREAT WESTERN MEDICAL GROUP PLLC

Practice address

118 Paul Bunyan Dr S
Bemidji, MN 56601-3236

Phone

(218) 770-9881

NPI assigned

Nov 17, 2017

Last updated

Nov 17, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Adam Hamilton, MD

Title

Owner

Phone

(218) 770-9881

Specialties & licenses 1

Addresses

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16307/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1510876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510876800000",
    "number": "1326552944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 PAUL BUNYAN DR S",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566013236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 PAUL BUNYAN DR S",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566013236",
            "telephone_number": "218-770-9881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT WESTERN MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-17",
        "last_updated": "2017-11-17",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ADAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-770-9881",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MN",
            "license": "53573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ravi N Gupta, D.D.S.
• Kathrine Elizabeth Haag, RDH

• Orthopaedic Surgery Physician in Bemidji, MN
• Providers in Bemidji, MN by specialty
• Orthopaedic Surgery Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.