Mayo Clinic Health System-Fairmont
Organization Active NPI Multi-Specialty Clinic/Center · Fairmont, MN
NPI 1366410862 · NPPES record last updated Apr 16, 2026
Key facts
- NPI
- 1366410862
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- MAYO CLINIC HEALTH SYSTEM-FAIRMONT
- Practice address
- 800 Medical Center Dr
Fairmont, MN 56031-4575 - Phone
- (507) 238-8100
- NPI assigned
- Mar 9, 2006
- Organization subpart
- No
Authorized official
- Name
- Morris Miller
- Title
- Cfo
- Phone
- (507) 594-6449
Other NPIs with the same Medicare PAC ID 2
Member of 1
Practitioners 916
-
Shantosh Adhikari Sharma, M.D.
-
Nandan S Anavekar, MBBCH
-
Usman Anwer, MD
-
John W Askew III, M.D.
-
Mark John Austin, MD
-
David Bartlett, M.D.
-
Meganne Bartsch, CNP
-
Stacy Marie Blank, CNP
-
John P Bois, MD
-
Mary Sarah Brandt, M.D.
-
Andrew K Brevik, D.O.
-
Brent R Bullis, M.D.
-
Erik Burnison, M.D.
-
Ingrid Chan, M.D.
-
Trevor Chan, M.D.
-
Andrew Zenhong Chow, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (5 enrollments) in MN, IA, WI, FL, AZ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040719000142 | MN | Part B Supplier - Clinic/Group Practice | 4981694981 |
Receives reassigned benefits from 872 practitioners Practice locations: Fairmont, MN; Blue Earth, MN; Windom, MN; Truman, MN; Trimont, MN; St James, MN; Rochester, MN; Mankato, MN… |
| O20060221000402 | IA | Part B Supplier - Clinic/Group Practice | 4981694981 |
Receives reassigned benefits from 2 practitioners Practice locations: Armstrong, IA |
| O20180104001216 | WI | Part B Supplier - Clinic/Group Practice | 4981694981 |
Receives reassigned benefits from 35 practitioners Practice locations: Eau Claire, WI; La Crosse, WI |
| O20180921001243 | FL | Part B Supplier - Clinic/Group Practice | 4981694981 |
Receives reassigned benefits from 1 practitioner Practice locations: Jacksonville, FL |
| O20181115002510 | AZ | Part B Supplier - Clinic/Group Practice | 4981694981 | Practice locations: Phoenix, AZ; Scottsdale, AZ |
National Provider Directory
Locations
411 S Grove St
Ste 3
Blue Earth, MN 56013
Phone (507) 526-4642
610 Summit Dr
Fairmont, MN 56031
Phone (507) 235-6606
204 2nd St
Jackson, MN 56143
Phone (507) 841-0060
400 N 4th Ave E
Truman, MN 56088
Phone (507) 762-2031
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
800 Medical Center Dr
Fairmont, MN 56031-4575
Mailing address
800 Medical Center Dr
Fairmont, MN 56031-4575
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5T402FA | Other | MN | BLUE CROSS BLUE SHIELD |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Other providers in Fairmont, MN
- Luke Matthew Madsen
- Andrew S Maiers
- Sarah Martinson
- Peggy Sue Mason
- Mayo Clinic Health System-Fairmont
- Mayo Clinic Health System-Fairmont
- Mayo Clinic Health System-Fairmont
- Mayo Clinic Hospital-Rochester
- Mayo Foundation for Medical Education & Research
- Susan A McCollough
All providers in Fairmont, MN · Multi-Specialty Clinic/Center in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.