PRIMARY CARE MANAGEMENT SERVICES, LLC (NPI# 1134641947) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134641947 |
| Entity Type | Organization |
| Organization Name | PRIMARY CARE MANAGEMENT SERVICES, LLC |
| Other Organization Name | MANNA HEALTH |
| Practice Address |
400 S State St Ste 55 Fairmont MN 56031-2872 |
| Practice Telephone | (507) 238-4844 |
| Practice Fax Number | 5072355542 |
| Mailing Telephone | 5072384844 |
| Mailing Fax Number | 5072355542 |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2017-07-13 |
| Authorized Official Name | TIMOTHY CHARLES BACHENBERG (CEO) |
| Authorized Official Telephone | 5072384844 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | PRIMARY CARE MANAGEMENT SERVICES, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 34448 | MN | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Manna Health | Doing Business As Name - Organization |
| Street Address |
400 S STATE ST STE 55 |
| City | FAIRMONT |
| State | MN |
| Zip Code | 56031-2872 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407097025 | David Robert Rynders | Counselor | 301 Downtown Plaza, #3, Fairmont, MN 56031 | 2009-03-11 |
| 1992902449 | Wal-mart Stores, Inc. | Technician/Technologist | 1250 Goemann Road, Fairmont, MN 56031 | 2007-06-28 |
| 1417099813 | Thomas Joe Larson | Dentist | 800 Clinic Circle, Fairmont, MN 56031 | 2007-02-13 |
| 1912076795 | Rem Heartland Inc | Intermediate Care Facility, Mentally Retarded | 111 Dorothy Street, Fairmont, MN 56031 | 2006-11-07 |
| 1750466322 | Rem Heartland Inc | Intermediate Care Facility, Mentally Retarded | 107 Dorothy Street, Fairmont, MN 56031 | 2006-10-25 |
| 1588744155 | Kerri Lynn Henderson | Chiropractor | 115 1/2 West Blue Earth Ave, Fairmont, MN 56031 | 2006-10-17 |
| 1427142199 | Maurice Lee Shoen | Counselor | 115 West First St, Fairmont, MN 56031 | 2006-10-03 |
| 1538253703 | Nathan Craig Jorgenson | Dentist | 717 South State Street, Suite 600, Fairmont, MN 56031 | 2006-10-03 |
| 1942311154 | Leon James Rochovitz | Optometrist | 288 S State Street, Five Lakes Centre, Fairmont, MN 56031 | 2006-08-31 |
| 1215903414 | Mayo Clinic Hospital-rochester | Clinic/Center | 835 Johnson Street, Fairmont, MN 56031 | 2006-02-27 |
| Find all providers in zip 56031 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043486145 | James Namsupak | Family Medicine | 401 Guffey St, John Manchin Sr. Health Care Center, Fairmont, WV 26554-4029 | 2008-05-08 |
| 1982779096 | Dulcimer Medical Center Pa | Family Medicine | 717 S State Street, Suite 800, Fairmont, MN 56031-4469 | 2006-11-22 |
| 1316037146 | Richard E Vasicek | Family Medicine | 177 Middletown Rd Ste 1, Fairmont, WV 26554-8254 | 2006-10-13 |
| 1134151228 | Hilsbos Family Care, Pllc | Family Medicine | 403 Virginia Ave Ste 202, Fairmont, WV 26554-2748 | 2006-07-07 |
| 1790714228 | Fairmont Physicians Inc | Family Medicine | 211 Marion Square, Fairmont, WV 26554 | 2006-06-30 |
| 1083656896 | Perry L Hall IIi | Family Medicine | 1836 Locust Avenue, Suite 1, Fairmont, WV 26554 | 2006-06-13 |
| 1881678738 | Duwayne Allen Hansen | Family Medicine | 1861 Knollwood Dr, Fairmont, MN 56031-2303 | 2005-12-05 |
| 1134103328 | Steven Wayne Sumey | Family Medicine | 322 S State St, Fairmont, MN 56031-4139 | 2005-12-01 |
| 1053395293 | Denise Schavey | Family Medicine | 1950 Center Creek Dr, Suite 100, Fairmont, MN 56031-3428 | 2005-12-01 |
| 1699775247 | Marilyn Judy Bonfili | Family Medicine | 1840 Locust Ave, Fairmont, WV 26554-1288 | 2005-07-26 |
| Find all providers in FAIRMONT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.