Mark Randy Halstrom, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

42506 Issued in MN

Practice address

100 2ND St S
Sartell, MN 56377-1977

Phone

(320) 251-2600

Fax

(320) 251-4763

NPI assigned

Jul 7, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 7

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

Specialty

Family Practice

Education

University of Minnesota Medical School, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Integracare LTDGroup PAC ID 6800780818, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mhalstrom1305@direct.centracare.com

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.

• Integracare LTD

  dba Williams Integracare Clinic

  • Family Medicine Physician
  • Sartell, MN
  • NPI 1770646937
  Medicare reassignment Care Compare group
• Integracare LTD

  dba Williams/Integracare Clinic

  • Family Medicine Physician
  • Sartell, MN
  • NPI 1982919395
  NPD Authorized official

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377561600000",
    "number": "1982601647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 296",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563770296",
            "telephone_number": "320-251-2600",
            "fax_number": "320-251-4763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 2ND ST S",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563771977",
            "telephone_number": "320-251-2600",
            "fax_number": "320-251-4763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALSTROM",
        "first_name": "MARK",
        "middle_name": "RANDY",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2013-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "42506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "339524300",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "169318P539",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP30911",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "41D31HA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "MR143-104661",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "01-05807",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIME WEST",
            "identifier": "031216004",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin James Hageman, PA-C
• Tatum Hagen
• Grace Victoria Hagstrom
• Augustine Navarro Hahn
• Hall Counseling LLC
• Randy Michael Halstrom
• Hands and Heart Chiropractic, P.a.
• Hanger Prosthetics & Orthotics East Inc (Hanger Clinic)
• Heather Marie Hansen
• Kaylee Marie Hansen

• Family Medicine Physician in Sartell, MN
• Providers in Sartell, 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 Aug 27, 2013; 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.

Verify at the official NPI Registry.