Individual provider Active NPI

Todd James McGovern, D.D.S.

  • General Practice Dentistry
  • Fergus Falls, MN
National Provider Identifier
1609955038
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10335 Issued in MN
Practice address
2001 W Lincoln Ave
Suite 33
Fergus Falls, MN 56537-1010
Phone
(218) 739-2481
Fax
(218) 739-2178
NPI assigned
Nov 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 10335 MN Primary

Addresses

Primary practice location

2001 W Lincoln Ave
Suite 33
Fergus Falls, MN 56537-1010

Mailing address

2001 W Lincoln Ave
Suite 33
Fergus Falls, MN 56537-1010
Phone (218) 739-2481

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150514000350 MN Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 0941520027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10335MNMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Lifesmiles Dental LLC General Practice 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.

NPI Registry JSON

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

{
    "created_epoch": "1162684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609955038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 W LINCOLN AVE",
            "address_2": "SUITE 33",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565371010",
            "telephone_number": "218-739-2481",
            "fax_number": "218-739-2178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 W LINCOLN AVE",
            "address_2": "SUITE 33",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565371010",
            "telephone_number": "218-739-2481",
            "fax_number": "218-739-2178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCGOVERN",
        "first_name": "TODD",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "10335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fergus Falls, MN

Sources for this page

Verify at the official NPI Registry.