NPIMap

Individual provider Active NPI

Darrel Richard Forslund Jr., M.D.

  • Family Medicine Physician
  • Spencer, IA
National Provider Identifier
1396783726
Registry record updated Sep 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DR0061273 Issued in CO
Practice address
1915 W 4TH St
Spencer, IA 51301-3006
Phone
(712) 262-5479
NPI assigned
Jun 4, 2006
Last updated
Sep 27, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 27694 IA
Family Medicine Physician 207Q00000X DR0061273 CO Primary

Addresses

Primary practice location

1915 W 4TH St
Spencer, IA 51301-3006

Mailing address

1915 W 4TH St
Spencer, IA 51301-3006
Phone (712) 262-5479

Other identifiers 1

IdentifierTypeStateIssuer
4057745MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181016003572 CO Practitioner - Family Practice 4385531573 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Iowa, RJ & L Carver College of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

222 Johnstown Ctr Dr
Johnstown, CO 80534-9030
Phone (970) 587-4974

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
27694IAMDEmergency Medicine Physician
DR0061273COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Health Physicians Colorado LLC CurrentSince Dec 1, 2018 Accepting new patients
Banner Health Physicians Colorado LLC CurrentSince Dec 1, 2018 Accepting new patients
Banner Health Physicians Colorado LLC Past Accepting new patients
Northwest Iowa Dermatology LLC Past Accepting new patients

Locations

1801 16th St
Greeley, CO 80631
Phone (970) 352-4121

1801 16th St
Ste C2B
Greeley, CO 80631
Phone (970) 810-4121

222 Johnstown Center Dr
Johnstown, CO 80534
Phone (970) 587-4974

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538006400000",
    "number": "1396783726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1915 W 4TH ST",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513013006",
            "telephone_number": "712-262-5479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 W 4TH ST",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513013006",
            "telephone_number": "712-262-5479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORSLUND",
        "first_name": "DARREL",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-04",
        "last_updated": "2018-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IA",
            "license": "27694",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR0061273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4057745",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spencer, IA

Sources for this page

Verify at the official NPI Registry.