David Christopher Anderholm, MD
Individual provider Active NPI Psychiatry Physician · Baxter, MN
NPI 1528039682 · NPPES record last updated Jun 17, 2011
Key facts
- NPI
- 1528039682
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 34543 (MN)
- Practice address
- 7115 Forthun Road
Suite 105
Baxter, MN 56425 - Phone
- (218) 454-0090
- Fax
- (218) 454-0091
- NPI assigned
- Jan 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 14
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- University of Minnesota Medical School, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Optum Behavioral Care of Colorado PC
Practice addresses (Care Compare)
7115 Forthun Rd
Suite 105
Baxter, MN 56425-8598
Phone (218) 454-0090
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 |
|---|---|---|---|---|
| I20050805000741 | MN | Practitioner - Psychiatry |
4880623206 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optum Behavioral Care of Colorado, P.C. | Current |
Accepting new patients | |
| David C. Anderholm, MD, PA | Psychiatry | Current |
Accepting new patients |
| Optum Behavioral Care of Colorado, P.C. | Current |
Accepting new patients |
Locations
7115 Forthun Rd
Ste 105
Baxter, MN 56425
Phone (218) 454-0090
7400 W 109th St
Bloomington, MN 55438
Phone (952) 886-3268
523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394
320 E Main St
Crosby, MN 56441
Phone (218) 546-7000
Interoperability endpoints
- david.anderholm.1@28621.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 34543 | MN | Yes |
Addresses
Primary practice location
7115 Forthun Road
Suite 105
Baxter, MN 56425
Mailing address
7115 Forthun Road
Suite 105
Baxter, MN 56425
Phone (218) 454-0090
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 503580500 | Medicaid | MN |
Other providers in Baxter, MN
- Anna M Ahrendt-Madsen
- Aim-Axness Integrative Medicine, PLLC
- Seraphine Aker
- Dante Rachelle Alexander
- Latricia Ann Alt-Peters
- Jeremy Anderson
- McKenzie Sue Anderson
- Michelle Lee Anderson
- Timothy James Anderson
- Aaron Antony
All providers in Baxter, MN · Psychiatry 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 Jun 17, 2011. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.