NPIMap

Organization Active NPI

North Dakota State University

  • Clinic/Center
  • Fargo, ND
National Provider Identifier
1427152115
Registry record updated Oct 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
NORTH DAKOTA STATE UNIVERSITY
Practice address
1707 Centennial Boulevard
Fargo, ND 58102
Phone
(701) 231-7331
Fax
(701) 231-6132
NPI assigned
Sep 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2018

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

Authorized official

Name
Teri Lynn Shepherd
Title
Insurance Coordinator
Phone
(701) 231-5239

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193200000X MULTI-SPECIALTY GROUP 183500000X 168 ND
Clinic/Center 261Q00000X Primary
Clinical Medical Laboratory 291U00000X 95503681 ND

Addresses

Primary practice location

1707 Centennial Boulevard
Fargo, ND 58102

Mailing address

PO Box 6050 Ndsu Dept. 5150
Ndsu Student Health Service
Fargo, ND 58108-6050
Phone (701) 231-7331

Other identifiers 1

IdentifierTypeStateIssuer
13139MedicaidND

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181023002704 ND Part B Supplier - Clinic/Group Practice 3173876000 Receives reassigned benefits from 7 practitioners
Practice locations: Fargo, ND

National Provider Directory

National Provider Directory
Tax ID family
North Dakota State University5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1707 Centennial Blvd
Fargo, ND 58102
Phone (701) 231-7331

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540252800000",
    "number": "1427152115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6050 NDSU DEPT. 5150",
            "address_2": "NDSU STUDENT HEALTH SERVICE",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581086050",
            "telephone_number": "701-231-7331",
            "fax_number": "701-231-6132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 CENTENNIAL BOULEVARD",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "58102",
            "telephone_number": "701-231-7331",
            "fax_number": "701-231-6132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH DAKOTA STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2018-10-23",
        "status": "A",
        "authorized_official_last_name": "SHEPHERD",
        "authorized_official_first_name": "TERI",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "701-231-5239"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": "ND",
            "license": "168",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "ND",
            "license": "95503681",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "13139",
            "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 Oct 23, 2018; 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.