Sedra Medical Clinic PLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

47271 Issued in MN

Legal business name

SEDRA MEDICAL CLINIC PLC

Practice address

213 Labree Ave N
Suite #207
Thief River Falls, MN 56701-2022

Phone

(218) 683-5137

Fax

(218) 683-5413

NPI assigned

Jan 9, 2013

Last updated

Jan 9, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Hazem Sedra, MDNPI 1669408753

Title

President

Phone

(218) 683-5137

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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.

• Hazem M Sedra, MD

  • Family Medicine Physician
  • Thief River Falls, MN
  • NPI 1669408753
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1357689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357689600000",
    "number": "1972840064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 LABREE AVE N",
            "address_2": "SUITE #207",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567012022",
            "telephone_number": "218-683-5137",
            "fax_number": "218-683-5413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 LABREE AVE N",
            "address_2": "SUITE #207",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567012022",
            "telephone_number": "218-683-5137",
            "fax_number": "218-683-5413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEDRA MEDICAL CLINIC PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-09",
        "last_updated": "2013-01-09",
        "status": "A",
        "authorized_official_last_name": "SEDRA",
        "authorized_official_first_name": "HAZEM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-683-5137",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "47271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1669408753",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "590610500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Kay Sayler, D.D.S.
• Michael Robert Schake, M.A. LP
• Mark R Schneider, MD
• Emily Jane Schuster, ADC-T
• Evan Cade Sconce, DNP, PMHNP-BC
• Hazem M Sedra, MD
• Barbara Ann Seeger
• Mya Seeger, COTA
• Shared Medical Technology, Inc
• Shoptikal LLC (Shopko Optical 4271)

• Family Medicine Physician in Thief River Falls, MN
• Providers in Thief River Falls, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.