MARK DAVID BOSTROM (MD) – Family Medicine Physician, NPI 1255860169
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,076 FAMILY PRACTICE in MN
Provider Addresses for MARK DAVID BOSTROM (MD)
330 N 8th Ave E
Duluth, MN 558052024
Phone: (218) 723-1112
Fax: (218) 725-2620
Type: Location
640 Jackson St
Saint Paul, MN 551012502
Phone: (651) 439-1234
Type: Location
400, East 3rd Street, Duluth, Saint Louis County, Minnesota, 55805, United States
MSS 6AV1-PE
DULUTH, MN 558051951
Phone: (218) 786-3146
Type: Mailing
8170 33RD AVE S
BLOOMINGTON, MN 554254516
Phone:
Type: Mailing
Westfields Hospital, 535, Hospital Road, New Richmond, Saint Croix County, Wisconsin, 54017, United States
NEW RICHMOND, WI 540171449
Phone: (715) 243-2600
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-02-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20201101000006 | I | Family Practice | WI | TBD |
| I20210211002877 | I | Family Practice | MN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 55805)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | WI | |
| Internal Medicine | MN | |
| Hospitalist, Internal Medicine | MN | |
| Family Practice | MN | |
| Certified Registered Nurse Anesthetist (Crna) | WI | |
| Family Practice | WI | |
| Family Practice | WI | |
| Emergency Medicine | MN | |
| Family Practice | WI | |
| Internal Medicine | OR |
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