NPIMap

Organization Active NPI

Gateway Family Health Clinic, LTD.

  • Clinic/Center
  • Cromwell, MN
National Provider Identifier
1891748042
Registry record updated Feb 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
497 Issued in MN
Legal business name
GATEWAY FAMILY HEALTH CLINIC, LTD.
Practice address
5565 Hwy. 210
Cromwell, MN 55726
Phone
(218) 644-3838
Fax
(218) 644-3067
NPI assigned
May 18, 2006
Last updated
Feb 14, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2008

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

Authorized official

Name
Mr. William G. Palmer
Title
Administrator
Phone
(218) 485-4491

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 497 MN Primary

Addresses

Primary practice location

5565 Hwy. 210
Cromwell, MN 55726

Mailing address

5565 Hwy. 210
Cromwell, MN 55726
Phone (218) 644-3838

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031104000556 MN Part B Supplier - Clinic/Group Practice 6305758657 Receives reassigned benefits from 19 practitioners
3 other NPIs on this enrollment
Practice locations: Moose Lake, MN; Sandstone, MN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202947200000",
    "number": "1891748042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5565 HWY. 210",
            "city": "CROMWELL",
            "state": "MN",
            "postal_code": "55726",
            "telephone_number": "218-644-3838",
            "fax_number": "218-644-3067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5565 HWY. 210",
            "city": "CROMWELL",
            "state": "MN",
            "postal_code": "55726",
            "telephone_number": "218-644-3838",
            "fax_number": "218-644-3067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY FAMILY HEALTH CLINIC, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2008-02-14",
        "status": "A",
        "authorized_official_last_name": "PALMER",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "218-485-4491",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": "497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cromwell, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.