Active NPI
Phil J Reisenauer, MT
- Community Health Worker
- Dickinson, ND
National Provider Identifier
1437427614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 93
- Practice address
- 188 Osborn Dr
Dickinson, ND 58601-3960 - Phone
- (701) 225-3906
- NPI assigned
- Dec 2, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 93 | ND | Primary |
Addresses
Primary practice location
188 Osborn Dr
Dickinson, ND 58601-3960
Mailing address
188 Osborn Dr
Dickinson, ND 58601-3960
Phone (701) 225-3906
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)
- Not enrolled
- Credentials
- Medical Technician
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322784000000",
"number": "1437427614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "188 OSBORN DR",
"city": "DICKINSON",
"state": "ND",
"postal_code": "586013960",
"telephone_number": "701-225-3906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "188 OSBORN DR",
"city": "DICKINSON",
"state": "ND",
"postal_code": "586013960",
"telephone_number": "701-225-3906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REISENAUER",
"first_name": "PHIL",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "MT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-12-02",
"last_updated": "2011-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "ND",
"license": "93",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dickinson, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.