Individual provider Active NPI

Luke Thomas Mike, DO

  • Student in an Organized Health Care Education/Training Program
  • Fargo, ND
National Provider Identifier
1437726304
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1919 Elm St N
Fargo, ND 58102-2416
Phone
(701) 293-4113
NPI assigned
Jun 8, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X RL17462 ND
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1919 Elm St N
Fargo, ND 58102-2416

Mailing address

1919 Elm St N
Fargo, ND 58102-2416
Phone (701) 293-4113

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MA, MT3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20231205001800 ND Practitioner - Psychiatry 6305294190 Reassigns benefits to 1 organization
I20241213002165 MA Practitioner - Psychiatry 6305294190 Reassigns benefits to 1 organization
I20260618001625 MT Practitioner - Psychiatry 6305294190 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2014 Washington St
Newton, MA 02462-1607
Phone (617) 243-6000

Hospital & facility affiliations

  • Newton-Wellesley Hospital Hospital, Newton, MA, CCN 220101

Merit-based Incentive Payment System (MIPS)

Final score
89.63 of 100Reported as group
Quality
89.39
Promoting interoperability
100
Improvement activities
40
Cost
76.04

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
RL17462NDMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
PSJ Acquisition LLC CurrentSince Oct 27, 2023 Accepting new patients
Mass General Brigham Medical Group Suburban Massachusetts Inc CurrentSince Dec 1, 2024 Accepting new patients
PSJ Acquisition LLC Psychiatry Current Accepting new patients

Locations

2014 Washington St
Newtonville, MA 02462
Phone (617) 243-6000

510 4th St S
Fargo, ND 58103
Phone (701) 476-7200

510 4th St S
#5
Fargo, ND 58103

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1623110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1437726304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 ELM ST N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581022416",
            "telephone_number": "701-293-4113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 ELM ST N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581022416",
            "telephone_number": "701-293-4113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKE",
        "first_name": "LUKE",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-08",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ND",
            "license": "RL17462",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.