Robert A Vennerstrom, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

33413 Issued in MN

Practice address

712 South Cascade Street
Fergus Falls, MN 56537-2813

Phone

(218) 736-8000

Fax

(218) 739-6742

NPI assigned

Sep 26, 2006

Last updated

Feb 16, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 11

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/e35355ac-dfca-48b9-9dd9-0b7c408c2a66/

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.

• Fergus Falls Medical Group, P.a.

  • Multi-Specialty Clinic/Center
  • Fergus Falls, MN
  • NPI 1285676031
  NPD
• Lake Region Healthcare Corporation

  • General Acute Care Hospital
  • Fergus Falls, MN
  • NPI 1093713372
  NPD
• Lake Region Healthcare Corporation

  • Chiropractor
  • Fergus Falls, MN
  • NPI 1265148480
  NPD

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487203200000",
    "number": "1437250800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 SOUTH CASCADE STREET",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565372813",
            "telephone_number": "218-736-8000",
            "fax_number": "218-739-6742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 SOUTH CASCADE STREET",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565372813",
            "telephone_number": "218-736-8000",
            "fax_number": "218-739-6742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENNERSTROM",
        "first_name": "ROBERT",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2017-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "33413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCAREMN",
            "identifier": "109371",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806646400",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "093007500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP27402",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAFFMG&WRC",
            "identifier": "01-00794",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "232419",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "80532VE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICABLC",
            "identifier": "01-14533",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200383400A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41091744413",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERREDONE",
            "identifier": "1008800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crystal Lynn Van Wert
• Lana Vanblaricom
• Jonie Lee Vanlerberghe, LPN
• Michael J Vanvalkenburg, MD
• Rachel Venberg, RN, PHN
• Wendy Kay Vierstraete, LPN
• Kayla Vigen, PHARM.D
• Vision World Inc (Vision World)
• Visionworks, Inc. (Visionworks)
• Vistad Chiropractic Clinic PA

• Family Medicine Physician in Fergus Falls, MN
• Providers in Fergus Falls, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.