Active NPI
Fergus Falls Medical Group, P.a.
- Clinic/Center
- Wheaton, MN
National Provider Identifier
1619915543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- License
- 44
- Legal business name
- FERGUS FALLS MEDICAL GROUP, P.A.
- Practice address
- 403 12TH St N
Wheaton, MN 56296-1070 - Phone
- (320) 563-8295
- Fax
- (320) 563-8014
- NPI assigned
- Jun 3, 2006
- Last updated
- Aug 17, 2018
- Organization subpart
- Yes
- Parent organization
- FERGUS FALLS MEDICAL GROUP, PA
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jim Wilkus
- Title
- Ceo
- Phone
- (218) 739-2221
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 44 | MN | Primary |
Addresses
Primary practice location
403 12TH St N
Wheaton, MN 56296-1070
Mailing address
615 S Mill St
Fergus Falls, MN 56537-2756
Phone (218) 739-2221
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00-01587 | Other | MN | WC MEDICA # |
| 109516 | Other | MN | WC UCARE # |
| 10344 | Medicaid | ND | |
| 62345FE | Other | MN | WC BCBS # |
Other names 1
- Wheaton Clinic
National Provider Directory
National Provider Directory- Part of
- Fergus Falls Medical Group
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
- Multi-Specialty Clinic/Center
- Fergus Falls, MN
- NPI 1285676031
Member Of
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149292800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1534464000000",
"number": "1619915543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 S MILL ST",
"city": "FERGUS FALLS",
"state": "MN",
"postal_code": "565372756",
"telephone_number": "218-739-2221",
"fax_number": "218-739-5501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "403 12TH ST N",
"city": "WHEATON",
"state": "MN",
"postal_code": "562961070",
"telephone_number": "320-563-8295",
"fax_number": "320-563-8014"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FERGUS FALLS MEDICAL GROUP, P.A.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FERGUS FALLS MEDICAL GROUP, PA",
"enumeration_date": "2006-06-03",
"last_updated": "2018-08-17",
"status": "A",
"authorized_official_last_name": "WILKUS",
"authorized_official_first_name": "JIM",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "218-739-2221"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "MN",
"license": "44",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WC MEDICA #",
"identifier": "00-01587",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WC UCARE #",
"identifier": "109516",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10344",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WC BCBS #",
"identifier": "62345FE",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Wheaton Clinic",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Wheaton, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.