NPIMap

Organization Active NPI

Innovis Health LLC

Doing business as Essentia Health West Acres Clinic

  • 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
Doing business as
Essentia Health West Acres Clinic
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
Last updated
Mar 1, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

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

IdentifierTypeStateIssuer
14510MedicaidND

Other names 1

  • Essentia Health West Acres Clinic Doing business as

Medicare participation

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

Enrollment records 1

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…

Other NPIs on the same Medicare enrollment 20

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

View all 20

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 47

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 47

NPI Registry JSON

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

{
    "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": "",
            "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.