Dermatology Professionals, PA

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

DERMATOLOGY PROFESSIONALS, PA

Practice address

1749 SE 2ND Ave
Grand Rapids, MN 55744-2576

Phone

(218) 454-7546

Fax

(218) 454-0390

NPI assigned

Nov 3, 2022

Last updated

Jun 12, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Paul Lundstrom, MDNPI 1699759647

Title

President

Phone

(218) 454-7546

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Other NPIs on the same Medicare enrollment 4

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

• Dermatology Professionals PA

  • Clinic/Center
  • Baxter, MN
  • NPI 1306196548

  O20071207000626

  Same enrollment
• Dermatology Professionals PA

  • Clinic/Center
  • Saint Cloud, MN
  • NPI 1720840788

  O20071207000626

  Same enrollment
• Dermatology Professionals, PA

  • Clinic/Center
  • Bemidji, MN
  • NPI 1356714182

  O20071207000626

  Same enrollment
• Dermatology Professionals, PA

  • Clinic/Center
  • Baxter, MN
  • NPI 1720269426

  O20071207000626

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Dermatology Professionals4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Dermatology Professionals PA

  • Clinic/Center
  • Baxter, MN
  • NPI 1306196548
  NPD tax ID
• Dermatology Professionals PA

  • Clinic/Center
  • Saint Cloud, MN
  • NPI 1720840788
  NPD tax ID
• Dermatology Professionals, PA

  • Clinic/Center
  • Bemidji, MN
  • NPI 1356714182
  NPD tax ID

Practitioners 2

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.

• Paul Lundstrom, MD

  • Dermatology Physician
  • Baxter, MN
  • NPI 1699759647
  NPD (past) Authorized official
• Kelley L Jensen, APRN, CNP

  • Family Nurse Practitioner
  • Grand Rapids, MN
  • NPI 1477108033
  NPD

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

{
    "created_epoch": "1667433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1467169979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13359 ISLE DR STE 3",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564252223",
            "telephone_number": "218-454-7546",
            "fax_number": "218-454-0390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1749 SE 2ND AVE",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557442576",
            "telephone_number": "218-454-7546",
            "fax_number": "218-454-0390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY PROFESSIONALS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-03",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "LUNDSTROM",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-454-7546",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arie Degrio
• Rhea Lou Valdez Del Rosario, PMHNP
• Rochelle Jean Delgreco, LICSW
• Denver Chiropractic PA (Denver Chiropractic)
• Gregory Emil Denver, D.C.
• Alan Jay Dettmer, PT
• Amy Marie Dolan, L.AC
• Drusilea Donato, LICSW
• Stephanie Lyn Downing
• Lauren G Dozier, FNP

• MOHS-Micrographic Surgery Physician in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• MOHS-Micrographic Surgery Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.