Individual provider Active NPI

Melanie A Hulm, PA-C

  • Physician Assistant
  • Fargo, ND
National Provider Identifier
1073391033
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PAC1021 Issued in ND
Practice address
4110 51St Ave S
Fargo, ND 58104-7776
Phone
(701) 364-3100
NPI assigned
Sep 20, 2023
Last updated
May 7, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 14911 MN
Physician Assistant 363A00000X PAC1021 ND Primary

Addresses

Primary practice location

4110 51St Ave S
Fargo, ND 58104-7776

Mailing address

400 E 3Rd Street
SSB6
Duluth, MN 55805-1951
Phone (218) 786-8364

Other names 1

  • Melanie Ann Loehrer Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20231020000978 ND Practitioner - Physician Assistant 4688020068 Reassigns benefits to 1 organization
I20240625002729 MN Practitioner - Physician Assistant 4688020068 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of North Dakota School of Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Regional Health CenterGroup PAC ID 2062326820, 190 clinicians
Innovis Health LLCGroup PAC ID 9931298155, 561 clinicians

Practice addresses (Care Compare)

1027 Washington Ave
Detroit Lakes, MN 56501-3409
Phone (218) 844-2300

1401 13TH Ave E
West Fargo, ND 58078-3468
Phone (701) 364-5751

208 Oppegard Ave NW
Twin Valley, MN 56584-4038
Phone (218) 584-5181

3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000

3902 13TH Ave S
Suite 3704
Fargo, ND 58103-7512
Phone (701) 364-6600

4110 51St Ave S
Fargo, ND 58104-7776
Phone (701) 364-3100

4476 31St Ave S
Suite 101
Fargo, ND 58104-4532
Phone (701) 234-9400

720 Main Ave
Moorhead, MN 56560-2752
Phone (218) 359-0399

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14911MNMDPhysician Assistant
PAC1021NDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Innovis Health, LLC. CurrentSince Oct 23, 2023 Accepting new patients
Innovis Health LLC CurrentSince Oct 23, 2023 Accepting new patients
Innovis Health, LLC CurrentSince Jun 3, 2024 Accepting new patients

Locations

1027 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 844-2300

400 E 3rd St
#6
Duluth, MN 55805
Phone (320) 360-1676

208 Oppegard Ave NW
Twin Valley, MN 56584
Phone (218) 584-5181

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

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-4222

4110 51st Ave S
Fargo, ND 58104
Phone (701) 364-3100

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 4

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": "1695168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1073391033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD STREET",
            "address_2": "SSB6",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 51ST AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047776",
            "telephone_number": "701-364-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HULM",
        "first_name": "MELANIE",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-20",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14911",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC1021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELANIE",
            "last_name": "LOEHRER",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.