NPIMap

Individual provider Active NPI

Charles Paul Tabor, MD

  • Family Medicine Physician
  • Grand Rapids, MN
National Provider Identifier
1740719640
Registry record updated Nov 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1740719640 Issued in MN
Practice address
1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone
(218) 999-1911
NPI assigned
Jun 6, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2021

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 64365 MN
Family Medicine Physician 207Q00000X 1740719640 MN Primary

Addresses

Primary practice location

1601 Golf Course Rd
Grand Rapids, MN 55744-8648

Mailing address

1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone (218) 786-3146

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
I20190625000312 MN Practitioner - Family Practice 2163756214 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grand Itasca Clinic and HospitalGroup PAC ID 8123939550, 328 clinicians

Practice addresses (Care Compare)

1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone (218) 326-3401

Hospital & facility affiliations

  • Grand Itasca Clinic and Hospital Hospital, Grand Rapids, MN, CCN 240064
  • North Memorial Health Hospital Hospital, Robbinsdale, MN, CCN 240001
  • Aspirus Lake View Hospital Hospital, Two Harbors, MN, CCN 241308

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1740719640MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake View Memorial Hospital, Inc CurrentSince Jun 1, 2019 Accepting new patients
Community Memorial Hospital Association CurrentSince Nov 1, 2021 Accepting new patients
Grand Itasca Clinic and Hospital CurrentSince Aug 1, 2020 Accepting new patients
Lake View Memorial Hospital, Inc. CurrentSince Jun 1, 2019 Accepting new patients
Grand Itasca Clinic and Hospital CurrentSince Aug 1, 2020 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

512 Skyline Blvd
Cloquet, MN 55720
Phone (218) 878-7207

1601 Golf Course Rd
Grand Rapids, MN 55744
Phone (218) 326-3401

111 SE 3rd St
Grand Rapids, MN 55744
Phone (218) 326-3401

325 11th Ave
Two Harbors, MN 55616
Phone (218) 834-5520

Interoperability endpoints

  • Direct secure messaging: charles.tabor.tabcha@lkv.direct.slhduluth.com

Organizations & group practices 5

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 8

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": "1496707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636675200000",
    "number": "1740719640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 GOLF COURSE RD",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557448648",
            "telephone_number": "218-786-3146",
            "fax_number": "218-725-2620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 GOLF COURSE RD",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557448648",
            "telephone_number": "218-999-1911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABOR",
        "first_name": "CHARLES",
        "middle_name": "PAUL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-06",
        "last_updated": "2021-11-12",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MN",
            "license": "64365",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "1740719640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MN

Sources for this page

Verify at the official NPI Registry.