NPIMap

Organization Active NPI

Innovis Health LLC

  • Family Medicine Physician
  • Fargo, ND
National Provider Identifier
1437495264
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
INNOVIS HEALTH LLC
Practice address
3902 13TH Ave S Ste 3704
Fargo, ND 58103-7512
Phone
(701) 364-6600
Fax
(701) 364-6628
NPI assigned
Dec 26, 2012
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Alan J Hurley
Title
Coo
Phone
(701) 364-7667

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Member organizations 14

Organizations listed as members of this organization in the National Provider Directory.

Practitioners 43

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

View all 43

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
35D0408379Essentia Health - West Acres3902 13TH Ave S, Fargo, ND 58103Certificate of waiverSep 30, 2027

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20071211000158 ND Part B Supplier - Clinic/Group Practice 9931298155 Receives reassigned benefits from 693 practitioners
22 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jamestown, ND; West Fargo, ND; Wahpeton, ND; Valley City, ND; Lisbon, ND; Hankinson, ND; Fargo, ND; Bismarck, ND…

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

3902 13TH Ave S Ste 3704
Fargo, ND 58103-7512

Mailing address

PO Box 1450 Nw7813
Minneapolis, MN 55485-7813
Phone (701) 364-3300

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
14510MedicaidND

Other names 1

NPPES NPI Registry
  • Essentia Health West Acres Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 1, 2024.

{
    "created_epoch": "1356480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1437495264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1450 NW7813",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554857813",
            "telephone_number": "701-364-3300",
            "fax_number": "701-364-8906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3902 13TH AVE S STE 3704",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581037512",
            "telephone_number": "701-364-6600",
            "fax_number": "701-364-6628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVIS HEALTH LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2012-12-26",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "HURLEY",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "701-364-7667"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14510",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health West Acres Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health West Acres Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.