Integracare LTD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1491 Issued in MN

Legal business name

INTEGRACARE LTD

Practice address

100 South 2ND Street
Sartell, MN 56377

Phone

(320) 251-2600

Fax

(320) 251-4763

NPI assigned

Aug 10, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Mark Randy Halstrom, MDNPI 1982601647

Title

Medical Director

Phone

(320) 251-2600

Specialties & licenses 3

Addresses

Other identifiers 15

Other names 1

• Williams/Integracare Clinic Doing business as

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Randy Halstrom, MD

  • Family Medicine Physician
  • Sartell, MN
  • NPI 1982601647
  NPD Authorized official
• Laureen Kay Bollmeyer, PT

  • Physical Therapist
  • Saint Cloud, MN
  • NPI 1518110576
  NPD
• Patricia Dianne Lindbom, PT

  • Physical Therapist
  • Saint Cloud, MN
  • NPI 1255308730
  NPD
• Dalita L Meyer, OT

  • Occupational Therapist
  • Aberdeen, SD
  • NPI 1285888958
  NPD
• Brianna Lynn Hoffarth, PT

  • Physical Therapist
  • Sartell, MN
  • NPI 1073749255
  NPD (past)
• Dean Alan Stulz, PA

  • Physician Assistant
  • Sartell, MN
  • NPI 1639275605
  NPD (past)
• Thomas Allen Sult, MD

  • Family Medicine Physician
  • New London, MN
  • NPI 1487651311
  NPD (past)

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

{
    "created_epoch": "1281398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548288000000",
    "number": "1982919395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SOUTH 2ND STREET",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "56377",
            "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 SOUTH 2ND STREET",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "56377",
            "telephone_number": "320-251-2600",
            "fax_number": "320-251-4763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRACARE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-10",
        "last_updated": "2019-01-24",
        "status": "A",
        "authorized_official_last_name": "HALSTROM",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "RANDY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "320-251-2600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "1491",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "1491",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "1491",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "079858400",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARAZ",
            "identifier": "1219767",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCS",
            "identifier": "31T18IN",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "1770646937",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "169318P539",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "1770646937",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "1770646937",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "1770646937",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "31T18IN",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH3371",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1770646937",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SELECT CARE",
            "identifier": "1770646937",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MMSI",
            "identifier": "1770646937",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "9823046",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNICARE",
            "identifier": "1770646937",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Williams/Integracare Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Williams/Integracare Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nawal Aden Ibrahim
• Ubah Afi Ibrahim
• Shamso Iman
• Independent Living Services of Central Minnesota
• Integracare LTD
• Interventional Pain & Physical Medicine Clinic
• Interventional Pain & Physical Medicine Clinic
• Interventional Pain & Physical Medicine Clinic
• Interventional Pain & Physical Medicine Clinic
• Leila Suleiman Maye Islow

• 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 Jan 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.