NPIMap

Organization Active NPI

St. Sophie's, LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Fargo, ND
National Provider Identifier
1336443654
Registry record updated Apr 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
7174 Issued in ND
Legal business name
ST. SOPHIE'S, LLC
Practice address
3201 33Rd St S
Fargo, ND 58104-8823
Phone
(701) 365-4488
Fax
(701) 365-0727
NPI assigned
Dec 29, 2010
Last updated
Apr 30, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2014

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

Authorized official

Name
Tracey Jean Frei
Title
Office Manager
Phone
(701) 365-4467

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 7174 ND
Adolescent and Children Mental Health Clinic/Center 261QM0855X 7174 ND Primary

Addresses

Primary practice location

3201 33Rd St S
Fargo, ND 58104-8823

Mailing address

3201 33Rd St S
Fargo, ND 58104-8823
Phone (701) 365-4488

Other identifiers 1

IdentifierTypeStateIssuer
15685MedicaidND

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110719000878 ND Part B Supplier - Clinic/Group Practice 7113195074 Receives reassigned benefits from 15 practitioners
Practice locations: Grand Forks, ND

National Provider Directory

National Provider Directory

Locations

3201 33rd St S
Fargo, ND 58104
Phone (701) 365-4467

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 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1293580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398816000000",
    "number": "1336443654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3201 33RD ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048823",
            "telephone_number": "701-365-4488",
            "fax_number": "701-365-0727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 33RD ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048823",
            "telephone_number": "701-365-4488",
            "fax_number": "701-365-0727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. SOPHIE'S, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-29",
        "last_updated": "2014-04-30",
        "status": "A",
        "authorized_official_last_name": "FREI",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "701-365-4467"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "ND",
            "license": "7174",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "ND",
            "license": "7174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15685",
            "state": "ND"
        }
    ],
    "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 Apr 30, 2014; 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.