NPIMap

Individual provider Active NPI

Laurie Annette Somerville, PA

  • Physician Assistant
  • Fargo, ND
National Provider Identifier
1003913898
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PAC0699 Issued in ND
Practice address
1720 University Dr S
Fargo, ND 58103-4940
Phone
(701) 280-4140
NPI assigned
Sep 20, 2006
Last updated
Oct 29, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH 7371 FL
Physician Assistant 363A00000X PA9108339 FL
Physician Assistant 363A00000X PAC0699 ND Primary

Addresses

Primary practice location

1720 University Dr S
Fargo, ND 58103-4940

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Other identifiers 2

IdentifierTypeStateIssuer
3815650-00MedicaidFL
55724ZOtherFLMEDICARE PTAN

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
I20171016003448 ND Practitioner - Physician Assistant 6103848619 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1720 University Dr S
Fargo, ND 58103-4940

3033 23Rd Ave S
Unit D
Fargo, ND 58103-6149

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.73 of 100Reported as group
Quality
71.75
Promoting interoperability
100
Improvement activities
40
Cost
70.68

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
CH 7371FLMDChiropractor
PA9108339FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo CurrentSince Sep 12, 2017 Accepting new patients
Sanford Medical Center Fargo Chiropractor Current Accepting new patients
Sanford Medical Center Fargo CurrentSince Sep 12, 2017 Accepting new patients
Somerville Health and Wellness, LLC Chiropractor PastSince Aug 28, 2012 Accepting new patients
Sanford Clinic North Past Accepting new patients

Locations

1720 University Dr S
Fargo, ND 58103
Phone (701) 280-4140

2301 25th St SW
Fargo, ND 58103
Phone (701) 234-7400

2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800

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

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/gatewaycsb/r4/

Organizations & group practices 5

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

Hospital & facility affiliations 6

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": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1003913898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940",
            "telephone_number": "701-280-4140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOMERVILLE",
        "first_name": "LAURIE",
        "middle_name": "ANNETTE",
        "name_prefix": "Dr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH 7371",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9108339",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3815650-00",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "55724Z",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.