Randall A Bostrom, MD
Individual provider Active NPI Family Medicine Physician · Mora, MN
NPI 1396705083 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1396705083
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 30066 (MN)
- Practice address
- 331 Highway 65 S
Mora, MN 55051-1899 - Phone
- (320) 679-1313
- Fax
- (320) 225-3141
- NPI assigned
- Mar 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100126000316 | MN | Practitioner - Family Practice |
0547302762 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30066 | MN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Welia Health | Current |
Accepting new patients | |
| Welia Health | Current | Accepting new patients |
Locations
301 Highway 65 S
Mora, MN 55051
Phone (320) 225-3317
331 Highway 65 S
Mora, MN 55051
Phone (320) 679-1212
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 30066 | MN | Yes |
Addresses
Primary practice location
331 Highway 65 S
Mora, MN 55051-1899
Mailing address
PO Box 43
Mr 10809
Minneapolis, MN 55440-0043
Phone (612) 262-4813
Other providers in Mora, MN
- Bio-Medical Applications of Minnesota, Inc.
- Kaitlyn Blanchard
- Susan Dorothy Blom
- Mary Kay Borgstrom
- Brenda Ann Bosaaen
- Shelley Bragelman
- Lori Braiedy
- Sadie Briana Broekemeier
- Joseph John Buckley
- Aimee Burk
All providers in Mora, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.