Individual provider Active NPI

Roderick Benjamin Brown, M.D.

  • Family Medicine Physician
  • Glenwood, MN
National Provider Identifier
1942214002
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
26202 Issued in MN
Practice address
10 4TH Ave SE
Glenwood, MN 56334-1820
Phone
(320) 634-2215
Fax
(320) 634-2262
NPI assigned
Jul 27, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 26202 MN Primary

Addresses

Primary practice location

10 4TH Ave SE
Glenwood, MN 56334-1820

Mailing address

10 4TH Ave SE
Glenwood, MN 56334-1820
Phone (320) 634-2215

Other identifiers 10

IdentifierTypeStateIssuer
01-08141OtherMEDICA
01-20641OtherMEDICA
01-06787OtherMEDICA
FP0356OtherARAZ
110886OtherUCARE
21082BROtherMNBLUE CROSS
39-40025OtherMEDICA
4T897BROtherMNBLUE CROSS
1004387OtherPREFERRED ONE
HP25406OtherHEALTH PARTNERS

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20110205000028 MN Practitioner - Family PracticePractitioner - General Surgery 6305026543 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Glacial Ridge Hospital DistrictGroup PAC ID 5294789194, 69 clinicians

Practice addresses (Care Compare)

10 4TH Ave SE
Glenwood, MN 56334-1820
Phone (320) 634-4521

417 Franklin St S
Glenwood, MN 56334-1518
Phone (320) 634-5157

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
26202MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Glacial Ridge Hospital District CurrentSince Jan 1, 1990 Accepting new patients
Glacial Ridge Hospital District Family Medicine Current Accepting new patients
Glacial Ridge Hospital District CurrentSince Jan 1, 1990 Accepting new patients
Glacial Ridge Hospital District Current Accepting new patients
Glacial Ridge Hospital District Past Accepting new patients

Locations

10 4th Ave SE
Glenwood, MN 56334
Phone (320) 634-5157

417 Franklin St S
Glenwood, MN 56334
Phone (320) 634-5157

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/glac-1755385c

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1942214002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 4TH AVE SE",
            "city": "GLENWOOD",
            "state": "MN",
            "postal_code": "563341820",
            "telephone_number": "320-634-2215",
            "fax_number": "320-634-2262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 4TH AVE SE",
            "city": "GLENWOOD",
            "state": "MN",
            "postal_code": "563341820",
            "telephone_number": "320-634-2215",
            "fax_number": "320-634-2262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "RODERICK",
        "middle_name": "BENJAMIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "26202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "01-08141",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "01-20641",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "01-06787",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARAZ",
            "identifier": "FP0356",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "110886",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "21082BR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "39-40025",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "4T897BR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1004387",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP25406",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenwood, MN

Sources for this page

Verify at the official NPI Registry.