NPIMap

Organization Active NPI

Northern Oral & Maxillofacial Surgeons, PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Duluth, MN
National Provider Identifier
1457401820
Registry record updated Mar 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
2467529001 Issued in MN
Legal business name
NORTHERN ORAL & MAXILLOFACIAL SURGEONS, PA
Practice address
3617 W Arrowhead Rd
Duluth, MN 55811-4046
Phone
(218) 722-8377
Fax
(218) 722-3117
NPI assigned
Jan 10, 2007
Last updated
Mar 5, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2008

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

Authorized official

Name
Charles R Babst, DDSNPI 1679623029
Title
President
Phone
(218) 722-8377

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 2467529001 MN Primary

Addresses

Primary practice location

3617 W Arrowhead Rd
Duluth, MN 55811-4046

Mailing address

3617 W Arrowhead Rd
Duluth, MN 55811-4046
Phone (218) 722-8377

Other identifiers 2

IdentifierTypeStateIssuer
60360BAOtherMNMINNESOTA BCBS CLINIC
38393400OtherWIWISCONSIN MEDICAID CLINIC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051221000235 MN Part B Supplier - Clinic/Group Practice 3072535863 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
Practice locations: Duluth, MN; Hibbing, MN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Northern Oral Maxillofacial Surgeons PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3617 W Arrowhead Rd
Duluth, MN 55811
Phone (218) 722-4484

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204675200000",
    "number": "1457401820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3617 W ARROWHEAD RD",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558114046",
            "telephone_number": "218-722-8377",
            "fax_number": "218-722-3117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3617 W ARROWHEAD RD",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558114046",
            "telephone_number": "218-722-8377",
            "fax_number": "218-722-3117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN ORAL & MAXILLOFACIAL SURGEONS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2008-03-05",
        "status": "A",
        "authorized_official_last_name": "BABST",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-722-8377",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "2467529001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA BCBS CLINIC",
            "identifier": "60360BA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN MEDICAID CLINIC",
            "identifier": "38393400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.