NPIMap

Organization Active NPI

Innovis Health, LLC.

  • Family Medicine Physician
  • Lisbon, ND
National Provider Identifier
1043490790
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
INNOVIS HEALTH, LLC.
Practice address
819 Main St
Lisbon, ND 58054-4244
Phone
(701) 683-4134
Fax
(701) 683-4094
NPI assigned
Nov 10, 2007
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Alan Hurley
Title
Coo
Phone
(701) 364-7667

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Practitioners 63

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 63

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
35D0408217Essentia Health Lisbon819 Main St, Lisbon, ND 58054Certificate of waiverMar 9, 2028

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20071211000158 ND Part B Supplier - Clinic/Group Practice 9931298155 Receives reassigned benefits from 693 practitioners
22 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jamestown, ND; West Fargo, ND; Wahpeton, ND; Valley City, ND; Lisbon, ND; Hankinson, ND; Fargo, ND; Bismarck, ND…

National Provider Directory

National Provider Directory

Locations

720 Main Ave
Moorhead, MN 56560
Phone (218) 359-0399

1711 Gold Dr S
Ste 160
Fargo, ND 58103
Phone (701) 234-9400

1600 Veterans Dr
Lisbon, ND 58054
Phone (701) 683-6500

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

819 Main St
Lisbon, ND 58054-4244

Mailing address

PO Box 1450 NW 7813
Minneapolis, MN 55485-7813
Phone (701) 253-5300

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
716483300MedicaidMN

Other names 1

NPPES NPI Registry
  • Essentia Health Lisbon Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 1, 2024.

{
    "created_epoch": "1194652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1043490790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1450 NW 7813",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554857813",
            "telephone_number": "701-253-5300",
            "fax_number": "701-253-5402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 MAIN ST",
            "city": "LISBON",
            "state": "ND",
            "postal_code": "580544244",
            "telephone_number": "701-683-4134",
            "fax_number": "701-683-4094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVIS HEALTH, LLC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2007-11-10",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "HURLEY",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "701-364-7667"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "716483300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Lisbon Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Lisbon Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lisbon, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.