Individual provider Active NPI

Miltiadis Douvoyiannis, MD

  • Pediatrics Physician
  • Grand Forks, ND
National Provider Identifier
1356692339
Registry record updated Jun 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
12926 Issued in ND
Practice address
1380 S Columbia Rd
Grand Forks, ND 58201-4059
Phone
(701) 795-2000
Fax
(701) 780-4477
NPI assigned
Oct 1, 2012
Last updated
Jun 18, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 12926 ND Primary
Pediatric Infectious Diseases Physician 2080P0208X 12926 ND

Addresses

Primary practice location

1380 S Columbia Rd
Grand Forks, ND 58201-4059

Mailing address

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

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mdouvoyiannis63646@direct.directaltru.org Direct

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130820000965 ND Practitioner - Pediatric MedicinePractitioner - Infectious Disease 2668614751 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12926NDMDPediatric Infectious Diseases Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Altru Health System Current Accepting new patients
Altru Health System CurrentSince Aug 1, 2013 Accepting new patients
Altru Health System CurrentSince Aug 1, 2013 Accepting new patients

Locations

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

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

960 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 780-5400

Interoperability endpoints

  • Direct secure messaging: mdouvoyiannis63646@direct.directaltru.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592438400000",
    "number": "1356692339",
    "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": "1380 S COLUMBIA RD",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014059",
            "telephone_number": "701-795-2000",
            "fax_number": "701-780-4477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUVOYIANNIS",
        "first_name": "MILTIADIS",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-01",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ND",
            "license": "12926",
            "primary": true
        },
        {
            "code": "2080P0208X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Infectious Diseases",
            "state": "ND",
            "license": "12926",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mdouvoyiannis63646@direct.directaltru.org",
            "affiliation": "N",
            "endpointDescription": "Direct mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1380 S Columbia Rd",
            "city": "Grand Forks",
            "state": "ND",
            "country_code": "US",
            "postal_code": "582014059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.