Individual provider Active NPI

Robert Dennis Staton, M.D.

  • Psychiatry Physician
  • Moorhead, MN
National Provider Identifier
1457398711
Registry record updated Apr 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
25212 Issued in MN
Practice address
1010 32ND Ave S
Moorhead, MN 56560-5001
Phone
(218) 233-7524
Fax
(218) 233-8627
NPI assigned
Jun 2, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 11, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 25212 MN Primary
Psychiatry Physician 2084P0800X 4169 ND

Addresses

Primary practice location

1010 32ND Ave S
Moorhead, MN 56560-5001

Mailing address

3001 Bohnet Blvd N
Fargo, ND 58102-1726

Other identifiers 5

IdentifierTypeStateIssuer
099398100MedicaidMN
59200STOtherMNBLUE SHIELD OF MINNESOTA
1455906MedicaidND
116458OtherMNUCARE MINNESOTA
1010543OtherMNPREFERREDONE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, ND2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20040621000073 MN Practitioner - Psychiatry 2365427861 Reassigns benefits to 1 organization
I20100223000241 ND Practitioner - Psychiatry 2365427861 Practice locations: Fargo, ND

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Miami, LM Miller School of Medicine, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lakeland Mental Health Center IncGroup PAC ID 1759291891, 39 clinicians

Practice addresses (Care Compare)

1010 S 32ND Ave
Moorhead, MN 56560-5001
Phone (218) 233-7524

980 S Tower Rd
Fergus Falls, MN 56537-5505
Phone (218) 736-6987

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Mental Health Center, Inc. CurrentSince Sep 1, 2003 Accepting new patients
Lakeland Mental Health Center Past Accepting new patients
Valley Christian Counseling Center Inc PastSince Sep 1, 1993 Accepting new patients
St Aloisius Hospital Inc Past Accepting new patients

Locations

980 S Tower Rd
Fergus Falls, MN 56537
Phone (218) 736-6987

1010 32nd Ave S
Moorhead, MN 56560
Phone (218) 233-7524

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491868800000",
    "number": "1457398711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 BOHNET BLVD N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581021726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 32ND AVE S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565605001",
            "telephone_number": "218-233-7524",
            "fax_number": "218-233-8627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATON",
        "first_name": "ROBERT",
        "middle_name": "DENNIS",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-02",
        "last_updated": "2017-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "25212",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ND",
            "license": "4169",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "099398100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF MINNESOTA",
            "identifier": "59200ST",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1455906",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MINNESOTA",
            "identifier": "116458",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERREDONE",
            "identifier": "1010543",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moorhead, MN

Sources for this page

Verify at the official NPI Registry.