Active NPI
Roger A. Ralston, MD
- Internal Medicine Physician
- Grand Rapids, MN
National Provider Identifier
1609853258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 21192
- Practice address
- 1601 Golf Course Rd
Grand Rapids, MN 55744-8648 - Phone
- (218) 326-5000
- NPI assigned
- Dec 26, 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 21192 | MN | Primary |
Addresses
Primary practice location
1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Mailing address
1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone (218) 326-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 531282500 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21192 | MN | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360195200000",
"number": "1609853258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 GOLF COURSE RD",
"city": "GRAND RAPIDS",
"state": "MN",
"postal_code": "557448648",
"telephone_number": "218-326-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 GOLF COURSE RD",
"city": "GRAND RAPIDS",
"state": "MN",
"postal_code": "557448648",
"telephone_number": "218-326-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RALSTON",
"first_name": "ROGER",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-26",
"last_updated": "2013-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MN",
"license": "21192",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "531282500",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.