Charles S Winjum, MD
Individual provider Active NPI Family Medicine Physician · Fosston, MN
NPI 1477583086 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1477583086
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 31170 (MN)
- Practice address
- 102 Sather Dr
Fosston, MN 56542-1531 - Phone
- (218) 435-1212
- Fax
- (221) 843-5130
- NPI assigned
- Jul 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060331000520 | MN | Practitioner - Family Practice | 9739197757 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31170 | MN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alluma, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 31170 | MN | Yes |
Addresses
Primary practice location
102 Sather Dr
Fosston, MN 56542-1531
Mailing address
PO Box 506
Fosston, MN 56542-0506
Phone (218) 435-1212
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0123282 | Other | MN | MEDCIA # |
| DA9071015707 | Other | MN | PREFERRED ONE # |
| MN100018 | Other | MN | LHS # |
| 915965 | Other | MN | AMERICIA'S PPO/ARAZ # |
| 116153 | Other | MN | UCARE # |
| 17708 | Other | MN | ND MEDICAID |
| 5T073WI | Other | MN | MNBS # |
| 12540 | Other | MN | NDBS # |
| HP20444 | Other | MN | HEALTHPARNTERS # |
| DA9021015707 | Other | MN | PREFERRED ONE # |
| 0105958 | Other | MN | MEDICA # |
| 054H4WI | Other | MN | MNBS # |
| 26610 | Other | MN | NDBS # |
Other providers in Fosston, MN
- Cheryl White
- Kristi Lea Widseth
- Gabriel L Wiener
- Sarah M Wills I
- Andrea Rose Wilson
- Nicholas Chandler Woods
All providers in Fosston, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.