NPIMap

Individual provider Active NPI

Kristen Renae Gourneau, NP

  • Family Nurse Practitioner
  • Fort Totten, ND
National Provider Identifier
1285293472
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R37632 Issued in ND
Practice address
3883 74TH Avenue
Fort Totten, ND 58335-5833
Phone
(701) 766-1600
NPI assigned
Jun 11, 2019
Last updated
Jun 11, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R37632 ND Primary

Addresses

Primary practice location

3883 74TH Avenue
Fort Totten, ND 58335-5833

Mailing address

1030 7TH St NE
Devils Lake, ND 58301-2720
Phone (218) 280-6153

Other identifiers 1

IdentifierTypeStateIssuer
R37632OtherNDNORTH DAKOTA BOARD OF NURSING

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190925000467 TX Practitioner - Nurse Practitioner 3779813373 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Quentin N Burdick Comprehensive Health Care FacilityGroup PAC ID 5496651853, 38 clinicians

Practice addresses (Care Compare)

PO Box
160 1300 Hospital Loop
Belcourt, ND 58316-0160

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
42.91 of 100Reported as group
Quality
5.54
Improvement activities
40
Cost
66.19

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Quentin N Burdick Comprehensive Health Care Facility CurrentSince Mar 12, 2022 Accepting new patients

Locations

1300 Hospital Loop
Belcourt, ND 58316

4100 W 150th St
#3
Cleveland, OH 44135

Organizations & group practices 1

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.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1285293472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 7TH ST NE",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583012720",
            "telephone_number": "218-280-6153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3883 74TH AVENUE",
            "city": "FORT TOTTEN",
            "state": "ND",
            "postal_code": "583355833",
            "telephone_number": "701-766-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOURNEAU",
        "first_name": "KRISTEN",
        "middle_name": "RENAE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-11",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "R37632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH DAKOTA BOARD OF NURSING",
            "identifier": "R37632",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Totten, ND

Sources for this page

Verify at the official NPI Registry.