NPIMap

Organization Active NPI

Integrated Intervention Specialists, LLC

  • Community/Behavioral Health Agency
  • Fargo, ND
National Provider Identifier
1275194136
Registry record updated Feb 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
INTEGRATED INTERVENTION SPECIALISTS, LLC
Practice address
4215 31St Ave S Ste a
Fargo, ND 58104-7743
Phone
(701) 478-0221
Fax
(701) 478-0222
NPI assigned
Jun 21, 2019
Last updated
Feb 1, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2025

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

Authorized official

Name
Jaclyn MartinsonNPI 1487182663
Title
Owner
Phone
(701) 341-6025

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary
Hearing and Speech Clinic/Center 261QH0700X

Addresses

Primary practice location

4215 31St Ave S Ste a
Fargo, ND 58104-7743

Mailing address

4215 31St Ave S Ste a
Fargo, ND 58104-7743
Phone (701) 478-0221

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230630001440 ND Part B Supplier - Clinic/Group Practice 1557720059 Receives reassigned benefits from 4 practitioners
Practice locations: Fargo, ND

National Provider Directory

National Provider Directory
Tax ID family
Integrated Intervention Specialists LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4215 31st Ave S
Ste A
Fargo, ND 58104
Phone (701) 478-0221

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 39

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.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1561075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738368000000",
    "number": "1275194136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4215 31ST AVE S STE A",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047743",
            "telephone_number": "701-478-0221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4215 31ST AVE S STE A",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047743",
            "telephone_number": "701-478-0221",
            "fax_number": "701-478-0222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED INTERVENTION SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-21",
        "last_updated": "2025-02-01",
        "certification_date": "2025-02-01",
        "status": "A",
        "authorized_official_last_name": "MARTINSON",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-341-6025"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2025; 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.