Active NPI
Mark R Gundersen, MD
- Family Medicine Physician
- Fergus Falls, MN
National Provider Identifier
1952390106
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 35677
- Practice address
- 712 South Cascade Street
Fergus Falls, MN 56537-2813 - Phone
- (218) 736-8000
- Fax
- (218) 739-6742
- NPI assigned
- Oct 20, 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301069187 | MI | |
| Family Medicine Physician | 207Q00000X | 35677 | MN | Primary |
Addresses
Primary practice location
712 South Cascade Street
Fergus Falls, MN 56537-2813
Mailing address
1216 Ryans Rd
Worthington, MN 56187-1722
Phone (507) 372-2921
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080093188 | Other | MI | METRAHEALTH |
| 4540600 | Medicaid | MI | |
| 5659321 | Other | MI | AETNA |
| 010G56026 | Other | MI | HEALTH PLUS |
| 0802502771 | Other | MI | BLUE CROSS BLUE SHIELD |
| 080D410020 | Other | MI | BLUE CROSS BLUE SHIELD |
| 204375 | Other | MI | MCLAREN HEALTH PLAN |
| F31478 | Other | MI | HEALTH NET FEDERAL |
| 204375 | Other | MI | HEALTH ADVANTAGE NETWORK |
| C4258 | Other | MI | MCARE |
| 080D410020 | Other | MI | BLUE CARE NETWORK |
| 7073962004 | Other | MI | CIGNA |
| F31478 | Other | MI | HEALTH ALLIANCE PLAN |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081007000057 | MN | Practitioner - Family Practice | 3274534441 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Minnesota Medical School, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1216 Ryans Rd
Worthington, MN 56187-1722
Phone (507) 372-2921
1216 Ryans Rd
Worthington, MN 56187-1781
Phone (507) 372-6522
941 County Rd
Suite 9
Heron Lake, MN 56137-1408
Phone (507) 793-2349
Hospital & facility affiliations
- Avera at Home Marshall
- Sanford Worthington Medical Center
- Avera McKennan Hospital & University Health Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avera McKennan | Current | Accepting new patients | |
| Rural Health Care, Inc | Family Medicine | Current | Accepting new patients |
| Avera McKennan | Current | Accepting new patients | |
| Avera McKennan | Family Medicine | Current | Accepting new patients |
| Rural Health Care, Inc | Current | Accepting new patients | |
| Fergus Falls Medical Group, P.a. | Family Medicine | Past | Accepting new patients |
Locations
300 S Bruce St
Ste 100
Marshall, MN 56258
1216 Ryans Rd
Ste 3
Worthington, MN 56187
Phone (507) 372-6522
1216 Ryans Rd
Worthington, MN 56187
Phone (507) 372-2921
Interoperability endpoints
- mark.gundersen@avera.sdhealthlink.net
Organizations & group practices 6
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.
-
- Federally Qualified Health Center (FQHC)
- Worthington, MN
- NPI 1215317375
Family Medicine, MN
-
- Federally Qualified Health Center (FQHC)
- Marshall, MN
- NPI 1740944602
-
- Diagnostic Radiology Physician
- Sioux Falls, SD
- NPI 1053680678
-
- Family Medicine Physician
- Fergus Falls, MN
- NPI 1730127812
Family Medicine
Hospital & facility affiliations 26
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Marshall, MN
- NPI 1033535547
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572307200000",
"number": "1952390106",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1216 RYANS RD",
"city": "WORTHINGTON",
"state": "MN",
"postal_code": "561871722",
"telephone_number": "507-372-2921",
"fax_number": "507-372-6523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "712 SOUTH CASCADE STREET",
"city": "FERGUS FALLS",
"state": "MN",
"postal_code": "565372813",
"telephone_number": "218-736-8000",
"fax_number": "218-739-6742"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUNDERSEN",
"first_name": "MARK",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-20",
"last_updated": "2019-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301069187",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "35677",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "METRAHEALTH",
"identifier": "080093188",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4540600",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5659321",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PLUS",
"identifier": "010G56026",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0802502771",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "080D410020",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCLAREN HEALTH PLAN",
"identifier": "204375",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NET FEDERAL",
"identifier": "F31478",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ADVANTAGE NETWORK",
"identifier": "204375",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCARE",
"identifier": "C4258",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE NETWORK",
"identifier": "080D410020",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "7073962004",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE PLAN",
"identifier": "F31478",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fergus Falls, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.