Steven Lynn Andersen, MD
Individual provider Active NPI Family Medicine Physician · Brainerd, MN
NPI 1962453993 · NPPES record last updated Nov 10, 2011
Key facts
- NPI
- 1962453993
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 40222 (MN)
- Practice address
- 16366 Pristine Pine CT
Brainerd, MN 56401-6278 - Phone
- (218) 232-7928
- NPI assigned
- May 15, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040214000128 | MN | Practitioner - Emergency Medicine |
8628962180 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40222 | MN | MD | Family Medicine Physician |
| 43122-020 | WI | MD | Family Medicine Physician |
| 8206A | WY | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sanford Health Network North | Current | Accepting new patients | |
| Sanford Health Network North | Current |
Accepting new patients | |
| Sanford Health Network North | Current |
Accepting new patients |
Locations
1720 US Highway 59 SE
Thief Rvr Fls, MN 56701
Phone (218) 681-4747
3001 Sanford Pkwy
Thief Rvr Fls, MN 56701
Phone (218) 681-4240
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 43122-020 | WI | |
| Family Medicine Physician | 207Q00000X | 40222 | MN | Yes |
| Family Medicine Physician | 207Q00000X | 8206A | WY |
Addresses
Primary practice location
16366 Pristine Pine CT
Brainerd, MN 56401-6278
Mailing address
16366 Pristine Pine CT
Brainerd, MN 56401-6278
Phone (218) 232-7928
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 106516500 | Medicaid | MN | |
| 34109000 | Medicaid | WI |
Other providers in Brainerd, MN
- Advocates for Reproductive Education
- Linda Marie Ahern
- Amy Aho
- Mary Jo Ambroz
- Laura Amundson
- Corey Robert Anderson
- Harvey E Anderson
- Janis D. Anderson
- Nicole Anderson
- Charles William Andres
All providers in Brainerd, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.