NPIMap

Individual provider Active NPI

Bangalore S Vijayalakshmi, MD

  • Physical Medicine & Rehabilitation Physician
  • Fargo, ND
National Provider Identifier
1003843574
Registry record updated Aug 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
9837 Issued in ND
Practice address
1702 University Dr S
Fargo, ND 58103-4940
Phone
(701) 364-3300
Fax
(701) 364-8906
NPI assigned
Jun 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 9837 ND Primary

Addresses

Primary practice location

1702 University Dr S
Fargo, ND 58103-4940

Mailing address

PO Box 6001
Fargo, ND 58108-6001
Phone (701) 364-3300

Other identifiers 11

IdentifierTypeStateIssuer
2265220OtherNDAMERICA'S PPO/ARAZ #
137123OtherNDUCARE #
DA9011042827OtherNDPREFERRED ONE #
HP48628OtherNDHEALTHPARTNERS #
25030OtherNDNDBS #
363627500MedicaidND
2300320OtherNDMEDICA #
927S3VIOtherNDMNBS #
13283MedicaidND
2300322OtherNDMEDICA #
38107OtherNDLHS #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041213001025 ND Practitioner - Physical Medicine and Rehabilitation 0446217210 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians
Pam Physician EnterpriseGroup PAC ID 1254628589, 34 clinicians

Practice addresses (Care Compare)

1220 Sheyenne St
West Fargo, ND 58078-2637
Phone (701) 234-4445

4671 38TH St S
Fargo, ND 58104-7866
Phone (701) 404-5100

801 Broadway N
Fargo, ND 58102-3641
Phone (701) 234-2000

Hospital & facility affiliations

  • Essentia Health Hospital, Fargo, ND, CCN 350070
  • Essentia Health St Marys - Detroit Lakes Hospital, Detroit Lakes, MN, CCN 240101
  • Pam Rehabilitation Hospital of Fargo Inpatient rehabilitation facility, Fargo, ND, CCN 353026
  • Sanford Health System Inpatient rehabilitation facility, Fargo, ND, CCN 35T011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9837NDMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pam Physician Enterprise Physical Medicine & Rehabilitation CurrentSince Jan 1, 2023 Accepting new patients
Innovis Health, LLC Current Accepting new patients
Sanford Medical Center Fargo CurrentSince Mar 1, 2021 Accepting new patients
Innovis Health LLC CurrentSince Jan 1, 2008 Accepting new patients
Innovis Health LLC CurrentSince Jan 1, 2008 Accepting new patients
Sanford Medical Center Fargo CurrentSince Mar 1, 2021 Accepting new patients
Sanford Medical Center Fargo Past Accepting new patients

Locations

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000

4671 38th St S
Fargo, ND 58104
Phone (701) 404-5100

1702 University Dr S
Fargo, ND 58103
Phone (701) 364-4222

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313971200000",
    "number": "1003843574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6001",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581086001",
            "telephone_number": "701-364-3300",
            "fax_number": "701-364-8906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940",
            "telephone_number": "701-364-3300",
            "fax_number": "701-364-8906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIJAYALAKSHMI",
        "first_name": "BANGALORE",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2011-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "ND",
            "license": "9837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICA'S PPO/ARAZ  #",
            "identifier": "2265220",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE #",
            "identifier": "137123",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE #",
            "identifier": "DA9011042827",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS #",
            "identifier": "HP48628",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NDBS #",
            "identifier": "25030",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "363627500",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA #",
            "identifier": "2300320",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MNBS #",
            "identifier": "927S3VI",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "13283",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA #",
            "identifier": "2300322",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LHS #",
            "identifier": "38107",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.