NPIMap

Individual provider Active NPI

Jeffrey P Scrivner, M.D.

  • Family Medicine Physician
  • Bigfork, MN
National Provider Identifier
1689649915
Registry record updated Jun 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
26152 Issued in MN
Practice address
135 Pine Tree Dr
Bigfork, MN 56628
Phone
(218) 743-3232
Fax
(218) 743-4223
NPI assigned
Feb 21, 2006
Last updated
Jun 25, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 26152 MN Primary

Addresses

Primary practice location

135 Pine Tree Dr
Bigfork, MN 56628

Mailing address

135 Pine Tree Dr
PO Box 135
Bigfork, MN 56628
Phone (218) 743-3232

Other identifiers 2

IdentifierTypeStateIssuer
714303600MedicaidMN
73321OtherMNMPIN

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
I20060404000424 MN Practitioner - Family Practice 6002803541 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cook Area Health Services, IncGroup PAC ID 4880681303, 27 clinicians

Practice addresses (Care Compare)

135 Pine Tree Dr
Bigfork, MN 56628-0135
Phone (218) 743-3232

135 Pine Tree Dr
Bigfork, MN 56628-4346

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26152MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cook Area Health Services, Inc Current Accepting new patients
Cook Area Health Services, Inc CurrentSince Jan 13, 1996 Accepting new patients
Cook Area Health Services, Inc Current Accepting new patients
Cook Area Health Services, Inc Family Medicine CurrentSince Jan 13, 1996 Accepting new patients
The Duluth Clinic, LTD. Past Accepting new patients
Cook Area Health Services, Inc Past Accepting new patients
Cook Area Health Services, Inc Past Accepting new patients

Locations

410 2nd St NW
Big Falls, MN 56627
Phone (218) 276-2403

135 Pine Tree Dr
Bigfork, MN 56628
Phone (218) 743-3232

20 5th St SE
Cook, MN 55723
Phone (218) 666-5941

12052 Main St
Northome, MN 56661
Phone (218) 897-5222

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Bigfork Valley CommunitiesBigfork, MN, CCN 245529 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Aug 1, 2002
Aug 1, 2002
Scenic Rivers Health ServicesBigfork, MN, CCN 241803 Federally qualified health center W-2 Managing Employee
Operational/Managerial Control		 Nov 1, 1984
Nov 1, 1984
Scenic Rivers Health ServicesNorthome, MN, CCN 241812 Federally qualified health center W-2 Managing Employee
Operational/Managerial Control		 Nov 1, 1987
Nov 1, 1984
Scenic Rivers Health ServicesBig Falls, MN, CCN 241811 Federally qualified health center Operational/Managerial Control Nov 1, 1984
Scenic Rivers Health ServicesTower, MN, CCN 241865 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jan 1, 2010
Apr 1, 1985

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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.

Hospital & facility affiliations 3

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": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1689649915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 PINE TREE DR",
            "address_2": "PO BOX 135",
            "city": "BIGFORK",
            "state": "MN",
            "postal_code": "56628",
            "telephone_number": "218-743-3232",
            "fax_number": "218-743-4223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 PINE TREE DR",
            "city": "BIGFORK",
            "state": "MN",
            "postal_code": "56628",
            "telephone_number": "218-743-3232",
            "fax_number": "218-743-4223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCRIVNER",
        "first_name": "JEFFREY",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "26152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "714303600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MPIN",
            "identifier": "73321",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bigfork, MN

Sources for this page

Verify at the official NPI Registry.