Cornerstone Clinic , PSC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

CORNERSTONE CLINIC , PSC

Practice address

410 Downtown PLZ
Fairmont, MN 56031-1714

Phone

(507) 848-8567

NPI assigned

Jul 17, 2023

Last updated

Apr 3, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Samantha FarnumNPI 1437518552

Title

Ceo

Phone

(507) 399-2100

Specialties & licenses 2

Addresses

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.

CLIA laboratory certificates

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Samantha Augusta Farnum, APRN

  • Family Nurse Practitioner
  • Fairmont, MN
  • NPI 1437518552
  Medicare reassignment Care Compare group NPD Authorized official
• Rebekah Jean Boer, NP-C

  • Family Nurse Practitioner
  • Fairmont, MN
  • NPI 1154631653
  Medicare reassignment Care Compare group NPD
• Lisa Marie Ertman, CNP

  • Primary Care Nurse Practitioner
  • Fairmont, MN
  • NPI 1508573288
  Medicare reassignment Care Compare group NPD
• Denver Jocylen Splinter, CNP

  • Nurse Practitioner
  • Estherville, IA
  • NPI 1558075747

  MN

  Medicare reassignment Care Compare group NPD
• Nathan Reyelts, PA-C

  • Physician Assistant
  • Fairmont, MN
  • NPI 1932183084
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1689552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1801575725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "778 245TH AVE",
            "city": "FAIRMONT",
            "state": "MN",
            "postal_code": "560314609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 DOWNTOWN PLZ",
            "city": "FAIRMONT",
            "state": "MN",
            "postal_code": "560311714",
            "telephone_number": "507-848-8567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE CLINIC , PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-17",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "FARNUM",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "507-399-2100"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trevor Chan, M.D.
• Christopher L. Olsen, DDS PLLC (Larson and Olsen Dental PA)
• Michael Daniel Clancey, D.C.
• Zephanie Cole, D.C.
• John Coniaris, MD
• Kelly Cowell
• Custom Clinic, P.a. (Smart Clinic)
• Zachary Dahl, ATC
• Shaylee Ranee Dallager, DNP
• Lindsay Ann Dalluge, R.D., L.D.

• Primary Care Clinic/Center in Fairmont, MN
• Providers in Fairmont, MN by specialty
• Primary Care Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; 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.