Active NPI
Joel R Haugen, MD
- Family Medicine Physician
- Fargo, ND
National Provider Identifier
1083643498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4721
- Practice address
- 3902 13TH Ave S
Fargo, ND 58103-3357 - Phone
- (701) 364-6600
- Fax
- (701) 364-6628
- NPI assigned
- Jun 30, 2006
- Last updated
- Aug 25, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4721 | ND | Primary |
| Family Medicine Physician | 207Q00000X | 25433 | MN |
Addresses
Primary practice location
3902 13TH Ave S
Fargo, ND 58103-3357
Mailing address
PO Box 6001
Fargo, ND 58108-6001
Phone (701) 364-3300
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0118705 | Other | ND | MEDICA # |
| 6438 | Other | MN | NDBS # |
| 0106129 | Other | ND | MEDICA # |
| 14615 | Medicaid | ND | |
| 644307900 | Medicaid | ND | |
| 676596 | Other | ND | AMERICA'S PPO/ARAZ # |
| 06004HA | Other | ND | MNBS # |
| HP19503 | Other | ND | HEALTHPARTNERS # |
| 63322HA | Other | ND | MNBS # |
| 63D98HA | Other | ND | MNBS # |
| 3T637HA | Other | ND | MNBS # |
| DA9011015641 | Other | ND | PREFERRED ONE # |
| ND100030 | Other | ND | LHS # |
| 169317 | Other | ND | UCARE # |
| 1735 | Other | ND | NDBS # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4721 | ND | MD | Pharmacist |
| 25433 | MN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Mary's Regional Health Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Essentia Health St. Mary's-Frazee Clinic
- Rural Health Clinic/Center
- Frazee, MN
- NPI 1902364482
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314230400000",
"number": "1083643498",
"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": "3902 13TH AVE S",
"city": "FARGO",
"state": "ND",
"postal_code": "581033357",
"telephone_number": "701-364-6600",
"fax_number": "701-364-6628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAUGEN",
"first_name": "JOEL",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-30",
"last_updated": "2011-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ND",
"license": "4721",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "25433",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA #",
"identifier": "0118705",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NDBS #",
"identifier": "6438",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA #",
"identifier": "0106129",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "14615",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "644307900",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICA'S PPO/ARAZ #",
"identifier": "676596",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MNBS #",
"identifier": "06004HA",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS #",
"identifier": "HP19503",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MNBS #",
"identifier": "63322HA",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MNBS #",
"identifier": "63D98HA",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MNBS #",
"identifier": "3T637HA",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE #",
"identifier": "DA9011015641",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LHS #",
"identifier": "ND100030",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE #",
"identifier": "169317",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NDBS #",
"identifier": "1735",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.