DR. BRUCE D FOSSEY (NPI# 1881689503) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881689503 |
| Entity Type | Individual |
| Full Name | DR. BRUCE D FOSSEY |
| Credential | M.D. |
| Practice Address |
4695 Shoreline Dr Spring Park MN 55384-9715 |
| Practice Telephone | 9524427895 |
| Practice Fax Number | 9524427894 |
| Mailing Telephone | 9524427895 |
| Mailing Fax Number | 9524427894 |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2008-05-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
22150 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 959598800 | 05 | |
| MN | BCBSM | 421LSP2 AND 421L13FO | 01 |
| FM | HEALTH PARTERS | 106524 | 01 |
| MN | PREFERREDONE | 1005202 | 01 |
| MN | AETNA | 4026961 | 01 |
| MN | MEDICA | 17-01333 | 01 |
| Street Address |
4695 SHORELINE DR |
| City | SPRING PARK |
| State | MN |
| Zip Code | 55384-9715 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912906017 | Mary Moe Trites | Family Medicine | 4695 Shoreline Dr, Spring Park, MN 55384-9715 | 2005-07-20 |
| 1437533858 | Heather Marie Wilson | Family Medicine | 4695 Shoreline Dr, Spring Park, MN 55384-9715 | 2015-07-15 |
| 1285808428 | Urology Associates, Ltd. | Urology | 4695 Shoreline Dr, Spring Park, MN 55384-9715 | 2008-04-18 |
| 1306041066 | Ridgeview Clinics | Physician Assistant | 4695 Shoreline Dr, Spring Park, MN 55384-9715 | 2007-06-20 |
| 1083743645 | James D Lehmann | Internal Medicine | 4695 Shoreline Dr, Spring Park, MN 55384-9715 | 2007-03-02 |
| 1740332253 | Ridgeview Clinics | Family Medicine | 4695 Shoreline Dr, Spring Park, MN 55384-9715 | 2007-01-17 |
| 1659389310 | Ridgeview Clinics | Family Medicine | 4695 Shoreline Dr, Spring Park, MN 55384-9715 | 2006-08-04 |
| 1255351342 | Steven Jay Nerheim | Family Medicine | 4695 Shoreline Dr, Spring Park, MN 55384-9715 | 2006-07-20 |
| 1902855539 | Eric A Nagle | Internal Medicine | 4695 Shoreline Dr, Spring Park, MN 55384-9715 | 2006-05-10 |
| 1033195813 | Jennifer H Rysso | Internal Medicine | 4695 Shoreline Dr, Spring Park, MN 55384-9715 | 2005-12-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164770756 | Watertown Pharmacy LLC | Pharmacy | 4689 Shoreline Drive, Suite 100, Spring Park, MN 55384 | 2012-08-29 |
| 1629451471 | Dantel Weaver | Dentist | 4100 Shoreline Dr, Spring Park, MN 55384-4508 | 2015-06-29 |
| 1629451000 | Aaron Tsay | Dentist | 4100 Shoreline Dr, Suite 4, Spring Park, MN 55384-4508 | 2015-07-03 |
| 1831677103 | Mitchell Lee Olson | Counselor | 4154 Shoreline Dr Ste 202, Spring Park, MN 55384-5606 | 2018-07-30 |
| 1235757600 | Mindfully Healing Inc. | Counselor | 4154 Shoreline Dr Ste 202, Spring Park, MN 55384-5606 | 2020-07-11 |
| 1679997480 | Phs/lake Minnetonka, LLC | Assisted Living Facility | 4527 Shoreline Dr, Spring Park, MN 55384-8706 | 2014-02-13 |
| 1184737926 | Phs Lake Minnetonka LLC | Skilled Nursing Facility | 4527 Shoreline Drive, Spring Park, MN 55384-8706 | 2006-08-16 |
| 1801247895 | Amanda Blom | Occupational Therapist | 4527 Shoreline Dr, Spring Park, MN 55384-8706 | 2016-06-30 |
| 1629676424 | Archy Olson | Behavior Technician | 2 Shoreline Pl, Spring Park, MN 55384-9644 | 2020-10-14 |
| 1750930525 | Kyle R Danielson, Dds, Pllc | Clinic/Center | 4165 Shoreline Dr Ste 30, Spring Park, MN 55384-9653 | 2019-09-05 |
| Find all providers in zip 55384 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265721757 | Yauhen Alexander Tarbunou | Surgery | 1200 6th Ave. N., St. Cloud, MN 56303-2735 | 2011-04-05 |
| 1083894836 | Vascular Surgery Associates Pa | Surgery | 3887 Coon Rapids Blvd Nw, Coon Rapids, MN 55433-2518 | 2007-11-09 |
| 1215947288 | Kamran Karimi | Surgery | 6405 France Ave S Ste W320, Edina, MN 55435-2188 | 2006-08-09 |
| 1649217159 | Roger S Hogue | Surgery | 7365 Kirkwood Ct N, Ste 120, Maple Grove, MN 55369-4721 | 2006-06-01 |
| 1720025455 | Rumi Faizer | Surgery | 314 Variety Club Research Center, 401 East River Parkway Division of Vascular Surgery, Minneapolis, MN 55455 | 2006-06-01 |
| 1518938067 | David Reed Knighton | Surgery | 2460 Highway 100 S, St Louis Park, MN 55416-1704 | 2006-01-31 |
| 1679100937 | Jesse Chait | Surgery | 200 1st St Sw, Rochester, MN 55905-0002 | 2020-03-26 |
| 1699235689 | Armin Farazdaghi | Surgery | 200 First Street Sw, Rochester, MN 55905-0001 | 2019-03-25 |
| 1093210262 | Nolan C Cirillo-penn | Surgery | 200 1st St Sw, Rochester, MN 55905 | 2018-03-28 |
| 1760915862 | Indrani Sen | Surgery | 200 1st St Sw, Mayo Clinic, Rochester, Rochester, MN 55905-0001 | 2017-04-05 |
| Find all providers with the same taxonomy | ||||
| City | SPRING PARK |
| Zip Code | 55384 |
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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.