NPIMap

Individual provider Active NPI

Bryon D Vandewege, MD

  • Family Medicine Physician
  • Roseau, MN
National Provider Identifier
1720174089
Registry record updated Jul 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
34974 Issued in MN
Practice address
711 Delmore Dr
Roseau, MN 56751-1534
Phone
(218) 463-1365
NPI assigned
Oct 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2012

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 34974 MN Primary

Addresses

Primary practice location

711 Delmore Dr
Roseau, MN 56751-1534

Mailing address

PO Box 6002
Grand Forks, ND 58206-6002
Phone (701) 780-5000

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
I20060428000466 MN Practitioner - Family Practice 9133139595 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Michigan Medical School, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Altru Health SystemGroup PAC ID 1355251604, 675 clinicians
Lifecare Medical CenterGroup PAC ID 4789586884, 55 clinicians

Practice addresses (Care Compare)

19120 200TH St
Greenbush, MN 56726-9280
Phone (218) 782-2400

711 Delmore Dr
Roseau, MN 56751-1534
Phone (218) 463-1365

715 Delmore Dr
Roseau, MN 56751-1534
Phone (218) 463-2500

Hospital & facility affiliations

  • Hia Hospice Hospice, Fargo, ND, CCN 351500
  • Lifecare Medical Center Hospital, Roseau, MN, CCN 241344
  • Lifecare Greenbush Manor Nursing home, Greenbush, MN, CCN 245616
  • Warroad Care Center Nursing home, Warroad, MN, CCN 245329
  • Lifecare Medical Center Nursing home, CCN 24Z344

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lifecare Medical Center CurrentSince Nov 10, 2013 Accepting new patients
Altru Health System CurrentSince Jul 1, 2020 Accepting new patients
Lifecare Medical Center CurrentSince Nov 10, 2013 Accepting new patients
Altru Health System Current Accepting new patients
Altru Health System CurrentSince Jul 1, 2020 Accepting new patients
Lifecare Medical Center Past Accepting new patients
Warroad Care Center, Inc. Past Accepting new patients

Locations

400 S Minnesota St
Crookston, MN 56716
Phone (218) 281-9100

19120 200th St
Ste 100
Greenbush, MN 56726
Phone (218) 782-2400

19120 200th St
Greenbush, MN 56726
Phone (218) 782-2400

715 Delmore Dr
Roseau, MN 56751
Phone (218) 463-2500

711 Delmore Dr
Roseau, MN 56751
Phone (218) 463-1365

715 Delmore Dr
Ste 100
Roseau, MN 56751
Phone (218) 463-1365

412 Main Ave NE
Warroad, MN 56763
Phone (218) 386-2020

2401 Demers Ave
Grand Forks, ND 58201
Phone (701) 780-1891

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Lifecare Medical CenterRoseau, MN, CCN 245470A Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 15, 2016
Apr 17, 2026
Lifecare Medical CenterGreenbush, MN, CCN 245616 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 15, 2016
Jan 15, 2016

Owned or controlled facilities with NPI records 2

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 and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343692800000",
    "number": "1720174089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6002",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582066002",
            "telephone_number": "701-780-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 DELMORE DR",
            "city": "ROSEAU",
            "state": "MN",
            "postal_code": "567511534",
            "telephone_number": "218-463-1365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDEWEGE",
        "first_name": "BRYON",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2012-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "34974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseau, MN

Sources for this page

Verify at the official NPI Registry.