Active NPI
David A Riley, M.D.
- Otolaryngology Physician
- Bemidji, MN
National Provider Identifier
1649245838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 59006
- Practice address
- 1300 Anne St NW
Bemidji, MN 56601-5103 - Phone
- (218) 333-5000
- NPI assigned
- Feb 21, 2006
- 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 8
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | MD00030575 | WA | |
| Facial Plastic Surgery Physician | 207YS0123X | MD00030575 | WA | |
| Otolaryngic Allergy Physician | 207YX0602X | MD00030575 | WA | |
| Otolaryngology/Facial Plastic Surgery Physician | 207YX0905X | MD00030575 | WA | |
| Surgery Physician | 208600000X | MD00030575 | WA | |
| Plastic and Reconstructive Surgery Physician | 2086S0122X | MD00030575 | WA | |
| Surgical Oncology Physician | 2086X0206X | MD00030575 | WA | |
| Otolaryngology Physician | 207Y00000X | 59006 | MN | Primary |
Addresses
Primary practice location
1300 Anne St NW
Bemidji, MN 56601-5103
Mailing address
PO Box 2010
Fargo, ND 58122-2484
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8227415 | Medicaid | WA | |
| MD00030575 | Other | WA | WA STATE MEDICAL LICENSE |
| 122444 | Other | WA | STATE LABOR & INDUSTRIES |
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 |
|---|---|---|---|
| 59006 | MN | MD | Otolaryngology Physician |
| MD00030575 | WA | MD | Surgical Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558656000000",
"number": "1649245838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2010",
"city": "FARGO",
"state": "ND",
"postal_code": "581222484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 ANNE ST NW",
"city": "BEMIDJI",
"state": "MN",
"postal_code": "566015103",
"telephone_number": "218-333-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RILEY",
"first_name": "DAVID",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-21",
"last_updated": "2019-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "WA",
"license": "MD00030575",
"primary": false
},
{
"code": "207YS0123X",
"taxonomy_group": "",
"desc": "Otolaryngology, Facial Plastic Surgery",
"state": "WA",
"license": "MD00030575",
"primary": false
},
{
"code": "207YX0602X",
"taxonomy_group": "",
"desc": "Otolaryngology, Otolaryngic Allergy",
"state": "WA",
"license": "MD00030575",
"primary": false
},
{
"code": "207YX0905X",
"taxonomy_group": "",
"desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
"state": "WA",
"license": "MD00030575",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WA",
"license": "MD00030575",
"primary": false
},
{
"code": "2086S0122X",
"taxonomy_group": "",
"desc": "Surgery, Plastic and Reconstructive Surgery",
"state": "WA",
"license": "MD00030575",
"primary": false
},
{
"code": "2086X0206X",
"taxonomy_group": "",
"desc": "Surgery, Surgical Oncology",
"state": "WA",
"license": "MD00030575",
"primary": false
},
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "MN",
"license": "59006",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8227415",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WA STATE MEDICAL LICENSE",
"identifier": "MD00030575",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LABOR & INDUSTRIES",
"identifier": "122444",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bemidji, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.