Thomas Ugelstad, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R46309 Issued in ND

Practice address

4656 Amber Valley Pkwy S Ste 102
Fargo, ND 58104-4594

Phone

(701) 251-0551

NPI assigned

Jun 2, 2022

Last updated

Oct 13, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ND

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• St. Sophie's, LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Fargo, ND
  • NPI 1336443654
  Medicare reassignment NPD
• Renew Psychiatry LLC

  dba Renew Psychiatry

  • Psychiatric/Mental Health Nurse Practitioner
  • Fargo, ND
  • NPI 1447082391
  NPD Authorized official

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

{
    "created_epoch": "1654128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728777600000",
    "number": "1285373738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4656 AMBER VALLEY PKWY S STE 102",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044594",
            "telephone_number": "701-251-0551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4656 AMBER VALLEY PKWY S STE 102",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044594",
            "telephone_number": "701-251-0551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UGELSTAD",
        "first_name": "THOMAS",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-02",
        "last_updated": "2024-10-13",
        "certification_date": "2024-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ND",
            "license": "R46309",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ND",
            "license": "R46309",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Nicole Twiss, RD, LRD
• Tyrone L Crew (Mediation Of The Self)
• Alissa Kristine Tyryfter
• Ashley Ann Ueckert, DC
• Nicole Ueckert, RN
• Marvin Lewis Ugland, DDS
• Sarah Uglem, PA-C
• Timothy P Uglem, DPM
• Sarah Uhler, LMT
• Iniobong Nnamdie Ukpong

• Psychiatric/Mental Health Nurse Practitioner in Fargo, ND
• Providers in Fargo, ND by specialty
• Psychiatric/Mental Health Nurse Practitioner in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.