NPIMap

Individual provider Active NPI

Mevan Nandaka Wijetunga, MD

  • Clinical Cardiac Electrophysiology Physician
  • Grand Forks, ND
National Provider Identifier
1457308645
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
48798 Issued in MN
Practice address
1300 S Columbia Rd
Grand Forks, ND 58201
Phone
(701) 780-6236
Fax
(701) 780-6221
NPI assigned
May 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 48798 MN
Cardiovascular Disease Physician 207RC0000X 48798 MN
Cardiovascular Disease Physician 207RC0000X MDE33460 DC
Clinical Cardiac Electrophysiology Physician 207RC0001X 11101 ND
Clinical Cardiac Electrophysiology Physician 207RC0001X 48798 MN Primary

Addresses

Primary practice location

1300 S Columbia Rd
Grand Forks, ND 58201

Mailing address

2401 Demers Ave
Grand Forks, ND 58201
Phone (701) 780-1891

Other identifiers 4

IdentifierTypeStateIssuer
15880581MedicaidVA
034425200MedicaidDC
967611200MedicaidMN
400766200MedicaidMD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mwijetunga28859@direct.directaltru.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, ND2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060818000028 MN Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 3072521640 Reassigns benefits to 2 organizations
I20090910000319 ND Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiac SurgeryPractitioner - Cardiovascular Disease (Cardiology) 3072521640 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Cardiovascular Disease (Cardiology)
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Altru Health SystemGroup PAC ID 1355251604, shared by 14 NPIs, 675 clinicians

Practice addresses (Care Compare)

1001 7TH St NE
Devils Lake, ND 58301-2719
Phone (701) 662-2157

1200 S Columbia Rd
Grand Forks, ND 58201-4036
Phone (701) 780-5000

1300 S Columbia Rd
Grand Forks, ND 58201-4012
Phone (701) 780-5000

1380 S Columbia Rd
Grand Forks, ND 58201-4059
Phone (701) 795-2000

400 S Minnesota St
Crookston, MN 56716-1808
Phone (218) 281-9100

4440 S Washington St
Grand Forks, ND 58201-7245
Phone (701) 780-5000

725 Hamline St
Grand Forks, ND 58203-2819
Phone (701) 780-6800

960 S Columbia Rd
Grand Forks, ND 58201-4030
Phone (701) 780-5400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MDE33460DCMDCardiovascular Disease Physician
48798MNMDClinical Cardiac Electrophysiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carris Health LLC CurrentSince Feb 28, 2018 Accepting new patients
Carris Health LLC CurrentSince Feb 28, 2018 Accepting new patients
Altru Health System CurrentSince Jun 23, 2020 Accepting new patients
Altru Health System CurrentSince Aug 3, 2009 Accepting new patients
Altru Health System CurrentSince Aug 3, 2009 Accepting new patients
Altru Health System Internal Medicine Current Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Ozarks Medical Center Past Accepting new patients
Altru Health System Past Accepting new patients

Locations

400 S Minnesota St
Crookston, MN 56716
Phone (218) 281-9100

607 Demers Ave
East Grand Forks, MN 56721
Phone (218) 773-0357

19120 200th St
Greenbush, MN 56726
Phone (218) 782-2400

711 Delmore Dr
Roseau, MN 56751
Phone (218) 463-1365

412 Main Ave NE
Warroad, MN 56763
Phone (218) 386-2020

301 Becker Ave SW
Willmar, MN 56201
Phone (320) 231-4120

1380 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 795-2000

1000 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 780-5089

1200 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 780-5243

2401 Demers Ave
Grand Forks, ND 58201
Phone (701) 780-1891

1300 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 780-2300

Interoperability endpoints

  • Direct secure messaging: mwijetunga28859@direct.directaltru.org

Organizations & group practices 9

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.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608595200000",
    "number": "1457308645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 DEMERS AVE",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-780-1891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 S COLUMBIA RD",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-780-6236",
            "fax_number": "701-780-6221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIJETUNGA",
        "first_name": "MEVAN",
        "middle_name": "NANDAKA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "48798",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MN",
            "license": "48798",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "DC",
            "license": "MDE33460",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "ND",
            "license": "11101",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "MN",
            "license": "48798",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15880581",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "034425200",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "967611200",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400766200",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwijetunga28859@direct.directaltru.org",
            "affiliation": "N",
            "endpointDescription": "direct mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1300 S Columbia Rd",
            "city": "Grand Forks",
            "state": "ND",
            "country_code": "US",
            "postal_code": "58201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.