Hagen Orthotics and Prosthetics

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

CO003977

Legal business name

HAGEN ORTHOTICS AND PROSTHETICS

Practice address

306 Becker Ave SW
Willmar, MN 56201-3341

Phone

(320) 222-3260

Fax

(320) 222-3262

NPI assigned

Jul 13, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Warren Hagen, CO, C.PED, PTA

Title

Owner/Orthotist

Phone

(320) 222-3260

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• HAGEN O & P Other name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1689699480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 BECKER AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562013341",
            "telephone_number": "320-222-3260",
            "fax_number": "320-222-3262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 BECKER AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562013341",
            "telephone_number": "320-222-3260",
            "fax_number": "320-222-3262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAGEN ORTHOTICS AND PROSTHETICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "HAGEN",
        "authorized_official_first_name": "WARREN",
        "authorized_official_title_or_position": "OWNER/ORTHOTIST",
        "authorized_official_telephone_number": "320-222-3260",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CO, C.PED, PTA"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": "CO003977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECT CARE",
            "identifier": "82-00440",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "360485300",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U CARE",
            "identifier": "164933",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1041315",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "235L7HA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "82-0040",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "99215",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HAGEN O & P",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kassondra Lorol Gustafson, LPCC
• Jonathan C Haas, MD
• Brenda Lynn Habedank, RPH
• Jon Haefner, D.C.
• Carly Hagemeyer, PHARM.D.
• Lia Marie Hagens
• Lee M Haggenjos, MD
• Hallowstone Willmar Operating LLC
• Kevin R Hallstrom, DDS
• Cheryl Block Hansen, LICSW

• All providers in Willmar, MN
• Prosthetic/Orthotic Supplier in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.