Katie L Tanner, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PAC0102 Issued in ND

Practice address

819 Main St
Lisbon, ND 58054-4244

Phone

(701) 683-4134

Fax

(701) 683-4094

NPI assigned

Dec 8, 2005

Last updated

Sep 12, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Innovis Health LLCGroup PAC ID 9931298155, 561 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• CHI Health at Home - HHA Home health agency, Valley City, ND, CCN 357035
• Hia Hospice Hospice, Fargo, ND, CCN 351500
• Essentia Health Hospital, Fargo, ND, CCN 350070
• Lisbon Area Health Services Hospital, Lisbon, ND, CCN 351311

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Innovis Health, LLC

  dba Essentia Health Fargo

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1215125463
  Medicare reassignment Care Compare group NPD (past)
• Innovis Health LLC

  dba Essentia Health-Osgood Clinic

  • Multi-Specialty Clinic/Center
  • Fargo, ND
  • NPI 1144776576
  NPD
• Innovis Health, LLC.

  dba Essentia Health Wahpeton Clinic

  • Family Medicine Physician
  • Wahpeton, ND
  • NPI 1790965440
  NPD
• North Dakota Veterans Home

  • Skilled Nursing Facility
  • Lisbon, ND
  • NPI 1821077025
  NPD (past)
• CHI Health Connect at Home-Fargo

  dba CHI Health at Home - Breckenridge

  • Health Service Clinic/Center
  • Breckenridge, MN
  • NPI 1215511167
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• CHI Health Connect at Home-Fargo

  dba CHI Health at Home

  • Home Health Agency
  • Valley City, ND
  • NPI 1265747737
  Care Compare affiliation
• Hospice of the Red River Valley

  dba HIA Hospice

  • Community Based Hospice Care Agency
  • Fargo, ND
  • NPI 1538253646
  Care Compare affiliation
• Innovis Health, LLC

  dba Essentia Health Fargo

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1215125463
  Care Compare affiliation
• Lisbon Area Health Services

  dba CHI Lisbon Health

  • Critical Access Hospital
  • Lisbon, ND
  • NPI 1609872431
  Care Compare affiliation

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

{
    "created_epoch": "1134000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568246400000",
    "number": "1225013634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 MAIN ST",
            "city": "LISBON",
            "state": "ND",
            "postal_code": "580544244",
            "telephone_number": "701-683-4134",
            "fax_number": "701-683-4094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNER",
        "first_name": "KATIE",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-08",
        "last_updated": "2019-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NDBS",
            "identifier": "19659",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05171",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Lisbon, ND
• Providers in Lisbon, ND by specialty
• Physician Assistant in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.