Mia M Kozojed, NP
Individual provider Active NPI Nurse Practitioner · Fargo, ND
NPI 1124281043 · NPPES record last updated Jul 10, 2008
Key facts
- NPI
- 1124281043
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- R30620 (ND)
- Practice address
- 737 Broadway N
Fargo, ND 58102-4421 - Phone
- (701) 234-5121
- Fax
- (701) 234-5124
- NPI assigned
- Jul 10, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 18
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- University of North Dakota School of Medicine, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sanford Health Network North
Practice addresses (Care Compare)
445 1St St E
Halstad, MN 56548-4142
Phone (218) 456-2158
600 1St St SE
Mayville, ND 58257-1518
Phone (701) 788-4500
Hospital & facility affiliations
- Sanford Mayville
- Sanford Hillsboro
- Sanford Medical Center Fargo
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ND, MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080813000054 | ND | Practitioner - Nurse Practitioner | 1759456627 | Reassigns benefits to 2 organizations |
| I20170511000197 | MN | Practitioner - Nurse Practitioner | 1759456627 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R30620 | ND | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sanford Medical Center Fargo | Current |
Accepting new patients | |
| Sanford Medical Center Fargo | Current |
Accepting new patients | |
| Sanford Health Network North | Current | Accepting new patients | |
| Sanford Health Network North | Current |
Accepting new patients |
Locations
445 1st St E
Halstad, MN 56548
Phone (218) 456-2158
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
737 Broadway N
Fargo, ND 58102
Phone (701) 234-4811
407 Washington Ave E
Finley, ND 58230
Phone (701) 524-1005
600 1st St SE
Mayville, ND 58257
Phone (701) 786-4500
42 6th Ave SE
Mayville, ND 58257
Phone (701) 786-3800
1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R30620 | ND | Yes |
Addresses
Primary practice location
737 Broadway N
Fargo, ND 58102-4421
Mailing address
737 Broadway
Fargo, ND 58122-0001
Phone (701) 234-5121
Other names
- Mia M Fyre
Other providers in Fargo, ND
- Sammantha Jeane Kouba
- Pelagia E Kouloumberis
- Evgueni E Kouznetsov
- Kelsey Jolene Kowalski
- Kory Kowalski
- Patricia Kpue
- Christopher Charles Kraemer
- Jennifer N Kraemer
- Katti Kraemer
- Michele Lucile Kraemer
All providers in Fargo, ND · Nurse Practitioner in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 10, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.