Active NPI
Bruce Frederick Dennison, MD
- Otolaryngology Physician
- Stillwater, MN
National Provider Identifier
1871578393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 36789
- Practice address
- 1500 Curve Crest Blvd W
Stillwater, MN 55082-6040 - Phone
- (651) 439-1234
- Fax
- (651) 275-3325
- NPI assigned
- Dec 7, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 24496 | WI | |
| Otolaryngology Physician | 207Y00000X | 36789 | MN | Primary |
Addresses
Primary practice location
1500 Curve Crest Blvd W
Stillwater, MN 55082-6040
Mailing address
8170 33Rd Ave S
Minneapolis, MN 55425-4516
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30475000 | Medicaid | WI | |
| 561516000 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24496 | WI | MD | Otolaryngology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ozarks Medical Center | Otolaryngology | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615766400000",
"number": "1871578393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8170 33RD AVE S",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554254516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 CURVE CREST BLVD W",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550826040",
"telephone_number": "651-439-1234",
"fax_number": "651-275-3325"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DENNISON",
"first_name": "BRUCE",
"middle_name": "FREDERICK",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-07",
"last_updated": "2021-03-15",
"certification_date": "2021-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "WI",
"license": "24496",
"primary": false
},
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "MN",
"license": "36789",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30475000",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "561516000",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stillwater, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.