Active NPI
Brian D Brattlof, MD
- Surgery Physician
- Park Rapids, MN
National Provider Identifier
1992751820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 33031
- Practice address
- 705 Pleasant Ave S
Park Rapids, MN 56470-1440 - Phone
- (218) 732-2800
- Fax
- (218) 732-2857
- NPI assigned
- May 25, 2006
- Last updated
- Sep 29, 2011
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 33031 | MN | Primary |
Addresses
Primary practice location
705 Pleasant Ave S
Park Rapids, MN 56470-1440
Mailing address
705 Pleasant Ave S
Park Rapids, MN 56470-1440
Phone (218) 732-2800
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700584 | Other | FM | MEDICA # |
| 1M789BR | Other | FM | MNBS # |
| 27943BR | Other | MN | MNBS # |
| 54913BR | Other | MN | MNBS # |
| 10475 | Other | MN | NDBS # |
| 1700499 | Other | FM | MEDICA # |
| 529297200 | Medicaid | FM | |
| MN200000 | Other | FM | LHS/BANNERHEALTH # |
| 20574BR | Other | MN | MNBS # |
| 10064 | Other | MN | NDBS # |
| 18686 | Medicaid | MN | |
| 819328 | Other | FM | AMERICA'S PPO/ARAZ # |
| 5117 | Other | MN | NDBS # |
| DA9041015604 | Other | FM | PREFERRED ONE # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 303314 | MN | MD | Addiction (Substance Use Disorder) Counselor |
| 33031 | MN | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317254400000",
"number": "1992751820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "705 PLEASANT AVE S",
"city": "PARK RAPIDS",
"state": "MN",
"postal_code": "564701440",
"telephone_number": "218-732-2800",
"fax_number": "218-732-2857"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 PLEASANT AVE S",
"city": "PARK RAPIDS",
"state": "MN",
"postal_code": "564701440",
"telephone_number": "218-732-2800",
"fax_number": "218-732-2857"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRATTLOF",
"first_name": "BRIAN",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-25",
"last_updated": "2011-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MN",
"license": "33031",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA #",
"identifier": "1700584",
"state": "FM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MNBS #",
"identifier": "1M789BR",
"state": "FM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MNBS #",
"identifier": "27943BR",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MNBS #",
"identifier": "54913BR",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NDBS #",
"identifier": "10475",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA #",
"identifier": "1700499",
"state": "FM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "529297200",
"state": "FM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LHS/BANNERHEALTH #",
"identifier": "MN200000",
"state": "FM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MNBS #",
"identifier": "20574BR",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NDBS #",
"identifier": "10064",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "18686",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICA'S PPO/ARAZ #",
"identifier": "819328",
"state": "FM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NDBS #",
"identifier": "5117",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE #",
"identifier": "DA9041015604",
"state": "FM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Park Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.