Active NPI
Harold Goodman Swennes III, DDS
- Dentist
- Chisolm, MN
National Provider Identifier
1528049624
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D8659
- Practice address
- 217 N W 1 St
Chisolm, MN 55719 - Phone
- (218) 254-3311
- Fax
- (218) 254-4531
- NPI assigned
- Nov 7, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D8659 | MN | Primary |
Addresses
Primary practice location
217 N W 1 St
Chisolm, MN 55719
Mailing address
PO Box 632
Chisholm, MN 55719-0632
Phone (218) 254-3311
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160727002303 | MN | Order and Referring Only - Dentist | 1052604071 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D8659 | MN | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chisholm Dental Service PA | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dental Clinic/Center
- Chisholm, MN
- NPI 1396807012
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1528049624",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 632",
"city": "CHISHOLM",
"state": "MN",
"postal_code": "557190632",
"telephone_number": "218-254-3311",
"fax_number": "218-254-4531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "217 N W 1 ST",
"city": "CHISOLM",
"state": "MN",
"postal_code": "55719",
"telephone_number": "218-254-3311",
"fax_number": "218-254-4531"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SWENNES",
"first_name": "HAROLD",
"middle_name": "GOODMAN",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D8659",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.