Prem Nath Pathak, MBBS

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

12788 Issued in ND

Practice address

1800 E Interstate Ave Ste B
Bismarck, ND 58503-1566

Phone

(701) 323-6543

Fax

(701) 323-5492

NPI assigned

Jul 20, 2009

Last updated

Apr 4, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in ND, NY2 enrollments

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 2

Specialty

Psychiatry

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sanford BismarckGroup PAC ID 9739098575, 562 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sanford Bismarck

  dba Family Wellness

  • Multi-Specialty Clinic/Center
  • Bismarck, ND
  • NPI 1811941172

  NY

  Medicare reassignment Care Compare group NPD
• Sanford Bismarck

  dba Sanford Health Occupational Medicine Clinic

  • Occupational Medicine Clinic/Center
  • Dickinson, ND
  • NPI 1669524351
  NPD

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

{
    "created_epoch": "1248048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649030400000",
    "number": "1417187907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-6585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 E INTERSTATE AVE STE B",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585031566",
            "telephone_number": "701-323-6543",
            "fax_number": "701-323-5492"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Sanford Seventh & Rosser Clinic 414 N 7th St",
            "address_purpose": "LOCATION",
            "city": "Bismarck",
            "state": "ND",
            "postal_code": "585014423",
            "country_code": "US",
            "telephone_number": "701-323-6543",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATHAK",
        "first_name": "PREM",
        "middle_name": "NATH",
        "credential": "MBBS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-20",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": "0116020790",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ND",
            "license": "12788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1451039",
            "state": "ND"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ppathak4798950@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "1800 E Interstate Ave Ste B",
            "city": "Bismarck",
            "state": "ND",
            "country_code": "US",
            "postal_code": "585031566",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ppathak4798950@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "Sanford Seventh & Rosser Clinic 414 N 7th St",
            "city": "Bismarck",
            "state": "ND",
            "country_code": "US",
            "postal_code": "585014423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Aaron Burke Patchen, DC
• Andrea L Patchen
• Mahesh N Patel, MD
• Poonam Patel
• Suhani Patel, MD
• Pathology Consultants, PC
• Kellen Elaine Pathroff, O.D.
• Robert Allen Pathroff, MD
• Pathway to Freedom
• Pathways to Freedom

• Psychiatry Physician in Bismarck, ND
• Providers in Bismarck, ND by specialty
• Psychiatry Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.