| Northwest Family Physicians Pa | |
|
5502 W Broadway Ave Suite 200 Crystal MN 55428-3508 | |
| (763) 504-6500 | |
| (763) 504-6544 |
| Full Name | Northwest Family Physicians Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 5502 W Broadway Ave, Crystal, Minnesota |
| Authorized Official Name and Position | Chris A Stuart (DOCTOR) |
| Authorized Official Contact | 7635046500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northwest Family Physicians Pa 5700 Bottineau Blvd. Suite 100 Crystal MN 55429 Ph: (763) 504-6500 | Northwest Family Physicians Pa 5502 W Broadway Ave Suite 200 Crystal MN 55428-3508 Ph: (763) 504-6500 |
| NPI Number | 1548366867 |
|---|---|
| Provider Enumeration Date | 09/15/2006 |
| Last Update Date | 10/26/2023 |
| Medicare PECOS PAC ID | 0042102956 |
|---|---|
| Medicare Enrollment ID | O20040326000077 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548366867 | NPI | - | NPPES |
| 469208000 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Kristine L Eskuchen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194716639 PECOS PAC ID: 3577468156 Enrollment ID: I20031205000477 |
| Provider Name | Joel A Sagedahl |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235110347 PECOS PAC ID: 2264334861 Enrollment ID: I20040123000659 |
| Provider Name | Christopher A Darnell |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1245204627 PECOS PAC ID: 6305806183 Enrollment ID: I20041015000419 |
| Provider Name | Joy L Westerdahl |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922089937 PECOS PAC ID: 1951293802 Enrollment ID: I20050523000184 |
| Provider Name | David C Sandell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568453926 PECOS PAC ID: 4385670371 Enrollment ID: I20050712000028 |
| Provider Name | Jonathan C Tallman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861467227 PECOS PAC ID: 8820013519 Enrollment ID: I20051012000020 |
| Provider Name | Natalie Anne Rehm |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053374488 PECOS PAC ID: 0941206759 Enrollment ID: I20061018000065 |
| Provider Name | Scott A Reichel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669577417 PECOS PAC ID: 9537167861 Enrollment ID: I20061121000650 |
| Provider Name | Kristen L Coulter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134397813 PECOS PAC ID: 2567549843 Enrollment ID: I20080410000649 |
| Provider Name | Jennifer J Riley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316111768 PECOS PAC ID: 7719057587 Enrollment ID: I20080605000262 |
| Provider Name | Nimalka P Jayatilleka |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982803334 PECOS PAC ID: 1456428341 Enrollment ID: I20080918000159 |
| Provider Name | Holly M Stenzel Taynton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578725347 PECOS PAC ID: 6406995950 Enrollment ID: I20091123000545 |
| Provider Name | Kathryn G Justesen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598756041 PECOS PAC ID: 2668506031 Enrollment ID: I20100820000375 |
| Provider Name | Chris A Stuart |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154312510 PECOS PAC ID: 4385768233 Enrollment ID: I20100828000166 |
| Provider Name | James M Welters |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992786735 PECOS PAC ID: 7517859465 Enrollment ID: I20100927001500 |
| Provider Name | Shelly L Anderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073594966 PECOS PAC ID: 9436041373 Enrollment ID: I20100927001518 |
| Provider Name | Gregory J Frane |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245211499 PECOS PAC ID: 9638061575 Enrollment ID: I20100927001528 |
| Provider Name | Ruby W Tam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194950303 PECOS PAC ID: 9335396233 Enrollment ID: I20120829000066 |
| Provider Name | Elisabeth J Mcclean |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003173469 PECOS PAC ID: 7113168766 Enrollment ID: I20130725000048 |
| Provider Name | Elizabeth F Severance |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700290319 PECOS PAC ID: 7810211877 Enrollment ID: I20150121002193 |
| Provider Name | Erica L Gathje |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417368796 PECOS PAC ID: 9335453398 Enrollment ID: I20150804005013 |
| Provider Name | Yazdaan R Juma |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649632324 PECOS PAC ID: 2961786199 Enrollment ID: I20190913001490 |
| Provider Name | Jennifer M Purifoy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396107470 PECOS PAC ID: 1153605373 Enrollment ID: I20200218000033 |
| Provider Name | Nneka N Agujiobi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588197537 PECOS PAC ID: 2668741562 Enrollment ID: I20201229001203 |
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