Fergus Falls Medical Group, P.a.

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

44 Issued in MN

Legal business name

FERGUS FALLS MEDICAL GROUP, P.A.

Practice address

410 Lake Ave S
Battle Lake, MN 56515

Phone

(218) 864-5283

Fax

(218) 864-8452

NPI assigned

Jun 15, 2006

Organization subpart

No

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

Authorized official

Name

Jim Wilkus

Title

Ceo

Phone

(218) 739-2221

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Battle Lake Clinic Other name

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

CLIA laboratory certificates

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376587972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 S MILL ST",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565372756",
            "telephone_number": "218-739-2221",
            "fax_number": "218-739-5501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 LAKE AVE S",
            "city": "BATTLE LAKE",
            "state": "MN",
            "postal_code": "56515",
            "telephone_number": "218-864-5283",
            "fax_number": "218-864-8452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FERGUS FALLS MEDICAL GROUP, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILKUS",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "218-739-2221"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MN",
            "license": "44",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLC MEDICA #",
            "identifier": "00-01587",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "13380",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLC UCARE #",
            "identifier": "115098",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLC BCBS #",
            "identifier": "62345FE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Battle Lake Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• John Gerald Chase, APRN, CNP, DC
• Lisa Cole
• Amy Louise Cory, RPH
• Kiana Marie Deal, PA-C
• Scott Edward Ellingson, D.C.
• Teresa Rae Koppang, MS CCCSLP
• Kelly Ann Kruschke, DNP, FNP-BC, RN
• Midwest Community Residential Services, Inc.
• Jay Harvey Olson
• Otter Tail County

• Multi-Specialty Clinic/Center in Battle Lake, MN
• Providers in Battle Lake, MN by specialty
• Multi-Specialty Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.