NPIMap

Individual provider Active NPI

Mitchell Julius Likness, PA-C

  • Physician Assistant
  • Fargo, ND
National Provider Identifier
1073091757
Registry record updated Aug 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12785 Issued in MN
Practice address
736 Broadway N
Fargo, ND 58102-4421
Phone
(605) 280-0669
NPI assigned
Aug 3, 2018
Last updated
Aug 17, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 12785 MN Primary

Addresses

Primary practice location

736 Broadway N
Fargo, ND 58102-4421

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-6585

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20181126003663 ND Practitioner - Physician Assistant 7012261373 Reassigns benefits to 1 organization
I20190507002226 MN Practitioner - Physician Assistant 7012261373 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

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

1412 Main St
Hawley, MN 56549
Phone (218) 483-3564

1710 Ctr Ave W
Dilworth, MN 56529-1309
Phone (701) 417-2575

1720 University Dr S
Fargo, ND 58103-4940
Phone (701) 234-2000

2801 University Dr S
Fargo, ND 58103-6029
Phone (701) 234-5673

5225 23Rd Ave S
Fargo, ND 58104-7927
Phone (701) 417-2575

712 S Cascade St
Fergus Falls, MN 56537-2913
Phone (218) 736-8000

736 Broadway N
Fargo, ND 58102-4421
Phone (701) 234-2000

737 Broadway N
Fargo, ND 58102-4421
Phone (701) 234-2000

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

907 S Mill St
Fergus Falls, MN 56537-2743
Phone (218) 739-6208

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
12785MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health Network North CurrentSince Mar 24, 2019 Accepting new patients
Sanford Medical Center Fargo CurrentSince Oct 22, 2018 Accepting new patients
Sanford Medical Center Fargo Current Accepting new patients
Sanford Health Network North CurrentSince Mar 24, 2019 Accepting new patients
Sanford Medical Center Fargo CurrentSince Oct 22, 2018 Accepting new patients
Sanford Medical Center Fargo CurrentSince Apr 7, 2021 Accepting new patients
Sanford Health Network North Past Accepting new patients
Sanford Medical Center Fargo Past Accepting new patients

Locations

1720 US Highway 59 SE
Thief Rvr Fls, MN 56701
Phone (218) 681-4747

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

5225 23rd Ave S
Fargo, ND 58104
Phone (701) 234-5933

736 Broadway N
Fargo, ND 58102
Phone (701) 234-2353

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

Organizations & group practices 9

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 10

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": "1533254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629158400000",
    "number": "1073091757",
    "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",
            "telephone_number": "605-328-6585",
            "fax_number": "605-328-6512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "736 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581024421",
            "telephone_number": "605-280-0669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIKNESS",
        "first_name": "MITCHELL",
        "middle_name": "JULIUS",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-03",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12785",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.