NPIMap

Individual provider Active NPI

Andre Spence, M.D.

  • Internal Medicine Physician
  • Bagley, MN
National Provider Identifier
1861621153
Registry record updated Jul 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
104420 Issued in MN
Practice address
123 4TH St NW
Bagley, MN 56621-8306
Phone
(218) 694-2384
NPI assigned
Jul 8, 2009
Last updated
Jul 8, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 104420 MN Primary

Addresses

Primary practice location

123 4TH St NW
Bagley, MN 56621-8306

Mailing address

85 Grandeville Rd SW
Apt 912
Rochester, MN 55902-3579

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
I20090901000627 MN Practitioner - Internal Medicine 0941355622 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1656 Central St W
Bagley, MN 56621-4357
Phone (218) 694-2384

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.56 of 100Reported as group
Quality
74.25
Promoting interoperability
100
Improvement activities
40
Cost
76.16

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
104420MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health of Northern Minnesota CurrentSince Mar 6, 2012 Accepting new patients
Sanford Health of Northern Minnesota Current Accepting new patients
Sanford Health of Northern Minnesota Internal Medicine CurrentSince Mar 6, 2012 Accepting new patients
Cornerstone Nursing and Rehab Center, Inc Past Accepting new patients
Sanford Health of Northern Minnesota Past Accepting new patients

Locations

123 4th St NW
Bagley, MN 56621
Phone (218) 694-2384

1656 Central St W
Bagley, MN 56621
Phone (218) 694-2384

203 4th St NW
Bagley, MN 56621
Phone (218) 694-3939

1611 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2020

22 Elm St
Clearbrook, MN 56634
Phone (218) 694-3124

22 Elm St
#67
Clearbrook, MN 56634
Phone (218) 776-3184

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1247011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247011200000",
    "number": "1861621153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 GRANDEVILLE RD SW",
            "address_2": "APT 912",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559023579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 4TH ST NW",
            "city": "BAGLEY",
            "state": "MN",
            "postal_code": "566218306",
            "telephone_number": "218-694-2384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPENCE",
        "first_name": "ANDRE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-08",
        "last_updated": "2009-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "104420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bagley, MN

Sources for this page

Verify at the official NPI Registry.