Individual provider Active NPI

Joseph M Grausgruber, D.C.

  • Chiropractor
  • Fargo, ND
National Provider Identifier
1083788012
Registry record updated Sep 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1072 Issued in ND
Practice address
4674 40TH Ave S Ste B
Fargo, ND 58104-4501
Phone
(701) 364-4105
NPI assigned
Nov 20, 2006
Last updated
Sep 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1072 ND Primary

Addresses

Primary practice location

4674 40TH Ave S Ste B
Fargo, ND 58104-4501

Mailing address

4674 40TH Ave S Ste B
Fargo, ND 58104-4501
Phone (701) 364-4105

Other identifiers 5

IdentifierTypeStateIssuer
7433163OtherPAAETNA
20-1808943OtherPATAX ID
251782835OtherPAASHN
408566OtherPAHIGHMARK
02694600OtherPACAPITAL BC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180316001351 ND Practitioner - Chiropractic 4981651502 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4674 40TH Ave S
Suite B
Fargo, ND 58104-4501
Phone (701) 364-4105

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1072NDMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Van Dam Chiropractic, PC CurrentSince Sep 30, 2019 Accepting new patients
Hershey 1 LLC Chiropractor PastSince Oct 1, 2017 Accepting new patients

Locations

1203 28th St S
#B
Fargo, ND 58103
Phone (701) 532-5320

Organizations & group practices 3

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695772800000",
    "number": "1083788012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4674 40TH AVE S STE B",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044501",
            "telephone_number": "701-364-4105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4674 40TH AVE S STE B",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044501",
            "telephone_number": "701-364-4105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAUSGRUBER",
        "first_name": "JOSEPH",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ND",
            "license": "1072",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7433163",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "20-1808943",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASHN",
            "identifier": "251782835",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "408566",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BC",
            "identifier": "02694600",
            "state": "PA"
        }
    ],
    "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 Sep 27, 2023; 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.