NPIMap

Individual provider Active NPI

Jason A Swelstad, D.D.S., M.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Fergus Falls, MN
National Provider Identifier
1609948066
Registry record updated Jul 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
D12921 Issued in MN
Practice address
321 Western Ave
Fergus Falls, MN 56537-2403
Phone
(218) 998-5000
Fax
(218) 739-2178
NPI assigned
Nov 14, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X 018533 MI
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X D12921 MN Primary

Addresses

Primary practice location

321 Western Ave
Fergus Falls, MN 56537-2403

Mailing address

321 Western Ave
Fergus Falls, MN 56537-2403
Phone (218) 998-5000

Other identifiers 1

IdentifierTypeStateIssuer
124643170MedicaidMI

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)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
018533MIMDOrthodontics and Dentofacial Orthopedic Dentist
D12921MNMDOrthodontics and Dentofacial Orthopedic Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Lifesmiles Dental LLC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311897600000",
    "number": "1609948066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 WESTERN AVE",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565372403",
            "telephone_number": "218-998-5000",
            "fax_number": "218-739-2178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 WESTERN AVE",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565372403",
            "telephone_number": "218-998-5000",
            "fax_number": "218-739-2178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SWELSTAD",
        "first_name": "JASON",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2011-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MI",
            "license": "018533",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MN",
            "license": "D12921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124643170",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fergus Falls, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.