Active NPI
James William Engstrom, O.D.
- Optometrist
- Fargo, ND
National Provider Identifier
1407967623
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 581
- Practice address
- 2101 Elm St N
Fargo, ND 58102-2417 - Phone
- (701) 239-3700
- Fax
- (701) 237-2683
- NPI assigned
- Aug 31, 2006
- Last updated
- Mar 18, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2579 | MN | |
| Optometrist | 152W00000X | 581 | ND | Primary |
Addresses
Primary practice location
2101 Elm St N
Fargo, ND 58102-2417
Mailing address
3238 43Rd Ave S
Fargo, ND 58104-6635
Phone (701) 298-0730
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 430628700 | Medicaid | MN |
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130519000005 | ND | Order and Referring Only - Optometry | 1456349935 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 581 | ND | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| James W. Engstrom, O.D. and Associates, PLLC | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Optometrist
- Dilworth, MN
- NPI 1932210150
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363564800000",
"number": "1407967623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3238 43RD AVE S",
"city": "FARGO",
"state": "ND",
"postal_code": "581046635",
"telephone_number": "701-298-0730",
"fax_number": "701-298-0730"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 ELM ST N",
"city": "FARGO",
"state": "ND",
"postal_code": "581022417",
"telephone_number": "701-239-3700",
"fax_number": "701-237-2683"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENGSTROM",
"first_name": "JAMES",
"middle_name": "WILLIAM",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2013-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "2579",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "ND",
"license": "581",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "430628700",
"state": "MN"
}
],
"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 Mar 18, 2013; 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.