Active NPI
Mark E Koivula, FNP-C
- Family Nurse Practitioner
- Bottineau, ND
National Provider Identifier
1265660740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R26131
- Practice address
- 516 Main St
Bottineau, ND 58318-1203 - Phone
- (701) 534-0109
- Fax
- (866) 640-0723
- NPI assigned
- Jun 23, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R26131 | ND | Primary |
Addresses
Primary practice location
516 Main St
Bottineau, ND 58318-1203
Mailing address
PO Box 419
Bottineau, ND 58318-0401
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R26131 | Other | ND | ND FNP LICENSE # |
| 1454625 | Medicaid | ND |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mark.koivula.1@19007.direct.athenahealth.com | Direct |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090904000234 | ND | Practitioner - Nurse Practitioner | 7315092871 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Pyramid Health LLC
Practice addresses (Care Compare)
516 Main St
Bottineau, ND 58318-1203
Phone (701) 534-0109
Hospital & facility affiliations
- St Andrew'S Hospital
- Trinity Hospitals
- CHI St Alexius Health
- Heart of America Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pyramid Health, LLC | Family | Current | Accepting new patients |
| Pospishil and Associates, PLLC | Past | Accepting new patients |
Locations
516 Main St
Bottineau, ND 58318
Phone (701) 245-6638
Interoperability endpoints
- mark.koivula.1@19007.direct.athenahealth.com
- https://api.platform.athenahealth.com/19007/brand/1/csg/1/fhir/r4
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Social Worker
- Minot, ND
- NPI 1134426463
Hospital & facility affiliations 9
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Substance Use Disorder Rehabilitation Hospital Unit
- Minot, ND
- NPI 1487804092
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647561600000",
"number": "1265660740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 419",
"city": "BOTTINEAU",
"state": "ND",
"postal_code": "583180401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 MAIN ST",
"city": "BOTTINEAU",
"state": "ND",
"postal_code": "583181203",
"telephone_number": "701-534-0109",
"fax_number": "866-640-0723"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOIVULA",
"first_name": "MARK",
"middle_name": "E",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-23",
"last_updated": "2022-03-18",
"certification_date": "2022-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "ND",
"license": "R26131",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ND FNP LICENSE #",
"identifier": "R26131",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1454625",
"state": "ND"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mark.koivula.1@19007.direct.athenahealth.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "516 Main St",
"city": "Bottineau",
"state": "ND",
"country_code": "US",
"postal_code": "583181203",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bottineau, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2022; 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.