Active NPI
Bruce P Conmy, MD
- Obstetrics & Gynecology Physician
- Detroit Lakes, MN
National Provider Identifier
1396795407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 29133
- Practice address
- 1027 Washington Ave
Detroit Lakes, MN 56501-3409 - Phone
- (218) 847-5611
- Fax
- (218) 847-0881
- NPI assigned
- May 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 29133 | MN | Primary |
| Obstetrics & Gynecology Physician | 207V00000X | 4645 | ND |
Addresses
Primary practice location
1027 Washington Ave
Detroit Lakes, MN 56501-3409
Mailing address
1027 Washington Ave
Detroit Lakes, MN 56501-3409
Phone (218) 847-5611
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0703070 | Other | MN | MEDICA |
| 585240896131 | Other | MN | PREFERRED ONE |
| 1396795407 | Medicaid | MN | |
| 189P8C0 | Other | MN | BC BS |
| 614072600 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4645 | ND | MD | Obstetrics & Gynecology Physician |
| 29133 | MN | MD | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355097600000",
"number": "1396795407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1027 WASHINGTON AVE",
"city": "DETROIT LAKES",
"state": "MN",
"postal_code": "565013409",
"telephone_number": "218-847-5611",
"fax_number": "218-847-0881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1027 WASHINGTON AVE",
"city": "DETROIT LAKES",
"state": "MN",
"postal_code": "565013409",
"telephone_number": "218-847-5611",
"fax_number": "218-847-0881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONMY",
"first_name": "BRUCE",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-11",
"last_updated": "2012-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "MN",
"license": "29133",
"primary": true
},
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "ND",
"license": "4645",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "0703070",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "585240896131",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1396795407",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC BS",
"identifier": "189P8C0",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "614072600",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit Lakes, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.