NPIMap

Individual provider Active NPI

Olatubosun Fashoro, MD

  • Internal Medicine Physician
  • Crookston, MN
National Provider Identifier
1700823598
Registry record updated Feb 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
49513 Issued in MN
Practice address
323 S Minnesota St
Crookston, MN 56716-1601
Phone
(218) 281-9603
Fax
(218) 281-9461
NPI assigned
Jun 1, 2006
Last updated
Feb 21, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 49513 MN Primary
General Practice Physician 208D00000X 9436 ND

Addresses

Primary practice location

323 S Minnesota St
Crookston, MN 56716-1601

Mailing address

323 S Minnesota St
Crookston, MN 56716-1601
Phone (218) 281-9603

Other identifiers 3

IdentifierTypeStateIssuer
946L3FAOtherMNBCBS MN
28040OtherBCBS ND
P00406999OtherRAILROAD MEDICARE

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
I20070523000208 MN Practitioner - Internal Medicine 7517064793 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Riverview Healthcare AssociationGroup PAC ID 7810806718, 46 clinicians
Sanford Health Network NorthGroup PAC ID 8022206663, shared by 16 NPIs, 114 clinicians

Practice addresses (Care Compare)

323 S Minnesota St
Crookston, MN 56716-1601
Phone (218) 281-9200

401 12TH St N
Wheaton, MN 56296-1070
Phone (320) 563-8971

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.91 of 100Reported as group
Quality
88.07
Promoting interoperability
100
Improvement activities
40
Cost
74.95

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
49513MNMDInternal Medicine Physician
9436NDMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Riverview Healthcare Association Current Accepting new patients
Riverview Healthcare Association CurrentSince May 7, 2007 Accepting new patients
Riverview Healthcare Association CurrentSince May 7, 2007 Accepting new patients
Riverview Healthcare Association CurrentSince Dec 20, 2025 Accepting new patients
Villa St. Vincent Past Accepting new patients
Riverview Healthcare Association Past Accepting new patients

Locations

323 S Minnesota St
Crookston, MN 56716
Phone (218) 281-9200

3001 Sanford Pkwy
Thief Rvr Fls, MN 56701
Phone (218) 681-4240

Organizations & group practices 6

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487635200000",
    "number": "1700823598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 S MINNESOTA ST",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567161601",
            "telephone_number": "218-281-9603",
            "fax_number": "218-281-9461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 S MINNESOTA ST",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567161601",
            "telephone_number": "218-281-9603",
            "fax_number": "218-281-9461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FASHORO",
        "first_name": "OLATUBOSUN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2017-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "49513",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "ND",
            "license": "9436",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MN",
            "identifier": "946L3FA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ND",
            "identifier": "28040",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00406999",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crookston, MN

Sources for this page

Verify at the official NPI Registry.