Valley Medical Clinic PC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

4806 Issued in ND

Legal business name

VALLEY MEDICAL CLINIC PC

Practice address

300 Main Ave
Ste 200
Fargo, ND 58103-1930

Phone

(701) 297-0817

Fax

(701) 297-6870

NPI assigned

Aug 19, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Panjini M Sivanna, M.D.NPI 1013948116

Title

President

Phone

(701) 297-0817

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Valley Internal Medicine Assoc Former legal business name

Medicare fee-for-service enrollment

Enrolled in ND, MN2 enrollments

Enrollment records 2

Locations

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Panjini M Sivanna, MD

  • Interventional Pain Medicine Physician
  • Thief River Falls, MN
  • NPI 1013948116

  ND

  Medicare reassignment NPD Authorized official
• Pamela Page Holtz, FNP-C

  • Family Nurse Practitioner
  • Fargo, ND
  • NPI 1982973251
  Medicare reassignment NPD
• Richard E Arness, DPM

  • Foot & Ankle Surgery Podiatrist
  • Fargo, ND
  • NPI 1902824600
  NPD (past)
• Prabhakar Rao Guduru, M.D

  • Geriatric Medicine (Internal Medicine) Physician
  • Fargo, ND
  • NPI 1427098540
  NPD (past)
• Kimberly Rae Kelly, MD

  • Dermatology Physician
  • Fargo, ND
  • NPI 1245223023
  NPD (past)
• Vinayak C Belamkar, MD

  • Interventional Pain Medicine Physician
  • Indianapolis, IN
  • NPI 1972586568
  NPD (past)
• Babu Rao Eladasari, MD,FACP

  • Internal Medicine Physician
  • Jacksonville, IL
  • NPI 1356393300
  NPD (past)
• Sepehr Khashaei, MD

  • Internal Medicine Physician
  • Albuquerque, NM
  • NPI 1508845751
  NPD (past)
• Mark L Peterson, OTR

  • Occupational Therapist
  • Ogema, MN
  • NPI 1578629341
  NPD (past)

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427932800000",
    "number": "1164537569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 MAIN AVE",
            "address_2": "STE 200",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031930",
            "telephone_number": "701-297-0817",
            "fax_number": "701-297-6870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MAIN AVE",
            "address_2": "STE 200",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031930",
            "telephone_number": "701-297-0817",
            "fax_number": "701-297-6870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY MEDICAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2015-04-02",
        "status": "A",
        "authorized_official_last_name": "SIVANNA",
        "authorized_official_first_name": "PANJINI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-297-0817",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "ND",
            "license": "4806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11224",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Internal Medicine Assoc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Valley Christian Counseling Center Inc
• Valley Dental Center, PC
• Valley Dermatology Clinic PC
• Valley Homes LLC
• Valley Laser Eye Center L.L.C.
• Valley Oral & Facial Surgery PC
• Valley Senior Services
• Valley Service Heating & Ac
• Tanner Valnes
• Van Dam Chiropractic, PC

• Pain Medicine (Anesthesiology) Physician in Fargo, ND
• Providers in Fargo, ND by specialty
• Pain Medicine (Anesthesiology) Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.