North Dakota Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

35C0001011 Issued in ND

Legal business name

NORTH DAKOTA SURGERY CENTER, LLC

Practice address

2600 47TH Ave South
Grand Forks, ND 58201

Phone

(701) 738-4248

Fax

(701) 775-3153

NPI assigned

Jun 23, 2005

Last updated

Feb 19, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer Boyd Baldock

Title

Officer and Authorized Official

Phone

(615) 234-5935

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Listed as

North Dakota Surgery Center LLCCCN 35C0001011

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Darin Tracy Leetun, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Grand Forks, ND
  • NPI 1225080476
  Medicare reassignment NPD
• David M Schall, MD

  • Orthopaedic Surgery Physician
  • Grand Forks, ND
  • NPI 1932170057
  NPD (past)

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1164428272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3035 DEMERS AVE",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014040",
            "telephone_number": "701-738-4240",
            "fax_number": "701-775-3153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 47TH AVE SOUTH",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-738-4248",
            "fax_number": "701-775-3153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH DAKOTA SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "BOYD",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED  OFFICIAL",
        "authorized_official_telephone_number": "615-234-5935"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "ND",
            "license": "35C0001011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10202",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandon K Nordstrom, OTR/L
• Parker Nordstrom
• Sherman Normandin, PHD
• North Dakota Eye Clinic, LTD
• North Dakota Eye Clinic, LTD
• Northeast Behavioral Health Clinic
• Northeast Behavioral Health Clinic
• Northeast Human Service Center
• Northeast Human Service Center
• Northern Natural Medicine PLLC

• Ambulatory Surgical Clinic/Center in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Ambulatory Surgical Clinic/Center in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; 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.