NPIMap

Individual provider Active NPI

Justin Mauch, MD

  • Neuroradiology Physician
  • Grand Forks, ND
National Provider Identifier
1295081461
Registry record updated Jun 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuroradiology PhysicianTaxonomy code 2085N0700X
License
PT15146 Issued in ND
Practice address
1200 S Columbia Rd
Grand Forks, ND 58201
Phone
(701) 780-5000
Fax
(701) 780-4477
NPI assigned
Jul 25, 2012
Last updated
Jun 15, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 107077 MN
Diagnostic Radiology Physician 2085R0202X 56991 MN
Diagnostic Radiology Physician 2085R0202X PT15146 ND
Neuroradiology Physician 2085N0700X PT15146 ND Primary

Addresses

Primary practice location

1200 S Columbia Rd
Grand Forks, ND 58201

Mailing address

2401 Demers Ave
Grand Forks, ND 58201
Phone (701) 780-1891

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, ND2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130801000893 MN Practitioner - Diagnostic Radiology 0547401564 Reassigns benefits to 1 organization
I20181019002186 ND Practitioner - Diagnostic Radiology 0547401564 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Altru Health SystemGroup PAC ID 1355251604, 675 clinicians

Practice addresses (Care Compare)

1200 S Columbia Rd
Grand Forks, ND 58201-4036
Phone (701) 780-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
PT15146NDMDNeuroradiology Physician
56991MNMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Altru Health System Current Accepting new patients
Altru Health System CurrentSince Jul 31, 2018 Accepting new patients
Altru Health System CurrentSince Jul 31, 2018 Accepting new patients
P R Health Corporation CurrentSince Jan 1, 2026 Accepting new patients
Mayo Clinic Health System-Lake City Current Accepting new patients
P R Health Corporation CurrentSince Jan 1, 2026 Accepting new patients

Locations

500 W Grant St
Lake City, MN 55041
Phone (651) 345-3321

1200 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 780-5243

1380 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 795-2000

2401 Demers Ave
Grand Forks, ND 58201
Phone (701) 780-1891

909 2nd St
Langdon, ND 58249
Phone (701) 256-6100

Organizations & group practices 6

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 5

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

NPI Registry JSON

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

{
    "created_epoch": "1343174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529020800000",
    "number": "1295081461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 DEMERS AVE",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-780-1891",
            "fax_number": "701-780-4477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S COLUMBIA RD",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-780-5000",
            "fax_number": "701-780-4477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAUCH",
        "first_name": "JUSTIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-25",
        "last_updated": "2018-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "107077",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "56991",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ND",
            "license": "PT15146",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "ND",
            "license": "PT15146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.