Tahereh Keshavarz, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PAC0409 Issued in ND

Practice address

700 1St Ave S
Meritcare Neuroscience Clinic -
Fargo, ND 58103

Phone

(701) 234-4036

Fax

(701) 234-4134

NPI assigned

Feb 17, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Center for Pain Medicine, P.a.

  • Pain Clinic/Center
  • Fargo, ND
  • NPI 1902217474
  Medicare reassignment
• Sanford Medical Center Fargo

  dba Sanford 1717 Medical Building

  • Family Medicine Physician
  • West Fargo, ND
  • NPI 1184917924
  Medicare reassignment
• Sanford Medical Center Fargo

  dba Sanford LaMoure Clinic

  • Rural Health Clinic/Center
  • Lamoure, ND
  • NPI 1164439196
  NPD
• Sanford Medical Center Fargo

  dba Sanford POWER Center

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1528009412
  NPD

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

{
    "created_epoch": "1234828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353456000000",
    "number": "1326287244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 1ST AVE S",
            "address_2": "MERITCARE NEUROSCIENCE CLINIC",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58103",
            "telephone_number": "701-234-4036",
            "fax_number": "701-234-4134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 1ST AVE S",
            "address_2": "MERITCARE NEUROSCIENCE CLINIC -",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58103",
            "telephone_number": "701-234-4036",
            "fax_number": "701-234-4134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KESHAVARZ",
        "first_name": "TAHEREH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-17",
        "last_updated": "2012-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ND",
            "license": "PAC0409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "71175",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Osman Keric
• Gloria Jean Kern, MSW
• Abigail Kerr
• Taylor Kersten
• Gail Ann Kerver, PHD
• Lori Kessel
• Ryan T Kessel, PAC
• Tracy Renee Kessel, OT
• Kate Christienne Kessler, D.O.
• Julie Marie Ketterling, FNP

• Medical Physician Assistant in Fargo, ND
• Providers in Fargo, ND by specialty
• Medical Physician Assistant in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2012; 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.