NPIMap

Individual provider Active NPI

Stefan Slocum Buetow, DO

  • Physical Medicine & Rehabilitation Physician
  • Burnsville, MN
National Provider Identifier
1689014169
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
62204 Issued in MN
Practice address
14000 Fairview Dr
Burnsville, MN 55337-5713
Phone
(952) 993-8700
NPI assigned
Jun 28, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 5101020778 MI
Physical Medicine & Rehabilitation Physician 208100000X 62204 MN Primary

Addresses

Primary practice location

14000 Fairview Dr
Burnsville, MN 55337-5713

Mailing address

1000 Oakland Dr
Kalamazoo, MI 49008-1282
Phone (269) 337-4400

Other practice location 1

1000 Oakland Dr
Kalamazoo, MI 49008-1282
Phone (269) 337-4400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170821003445 MN Practitioner - Physical Medicine and Rehabilitation 5294967527 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

14000 Fairview Dr
Burnsville, MN 55337-5713
Phone (952) 993-8700

Hospital & facility affiliations

  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
62204MNMDPhysical Medicine & Rehabilitation Physician
5101020778MIMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Jul 31, 2017 Accepting new patients
Park Nicollet Clinic CurrentSince Jul 31, 2017 Accepting new patients
Park Nicollet Clinic Current Accepting new patients

Locations

14000 Fairview Dr
Burnsville, MN 55337
Phone (952) 993-8608

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

3800 Park Nicollet Blvd
St Louis Park, MN 55416
Phone (952) 993-1000

Organizations & group practices 3

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1372377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1689014169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 OAKLAND DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490081282",
            "telephone_number": "269-337-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14000 FAIRVIEW DR",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553375713",
            "telephone_number": "952-993-8700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Oakland Dr",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490081282",
            "country_code": "US",
            "telephone_number": "269-337-4400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUETOW",
        "first_name": "STEFAN",
        "middle_name": "SLOCUM",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-28",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "5101020778",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MN",
            "license": "62204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

Verify at the official NPI Registry.