Jillian Marie Hallstrom, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

38195 Issued in MN

Practice address

5700 Bottineau Blvd
#210
Crystal, MN 55429-3183

Phone

(763) 587-7000

Fax

(763) 587-7015

NPI assigned

Aug 31, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• North Memorial Health Care

  dba North Memorial Health Hospital

  • General Acute Care Hospital
  • Robbinsdale, MN
  • NPI 1851344907
  Medicare reassignment NPD
• Premier OBGYN of Minnesota PLLC

  • Obstetrics & Gynecology Physician
  • Edina, MN
  • NPI 1801946223
  Medicare reassignment NPD
• North Memorial Health Care

  • Clinic/Center
  • Blaine, MN
  • NPI 1841995552
  NPD
• North Memorial Health Care

  dba North Memorial Health Specialty Clinic

  • Medical Specialty Clinic/Center
  • Robbinsdale, MN
  • NPI 1871927715
  NPD

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403049600000",
    "number": "1780795575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 BOTTINEAU BLVD",
            "address_2": "#210",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554293183",
            "telephone_number": "763-587-7000",
            "fax_number": "763-587-7015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 BOTTINEAU BLVD",
            "address_2": "#210",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554293183",
            "telephone_number": "763-587-7000",
            "fax_number": "763-587-7015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLSTROM",
        "first_name": "JILLIAN",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2014-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "38195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "433027700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tammy Gregerson, P.A.-C
• Amina Mohamed Guled
• Laura Lee Haeg, MA, LADC, LPCC
• Gary Lee Hahn Jr., D.C.
• Keyonta Shannon Hall
• Kimberly Jane Haney
• Lee Hanson, PHARM. D
• Shannon E Harris, MD
• Breanna Hartford
• Fatima Hassan

• Obstetrics & Gynecology Physician in Crystal, MN
• Providers in Crystal, MN by specialty
• Obstetrics & Gynecology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.