Dolores I Van Bourgondien, ANP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R54243 Issued in ND

Practice address

3674 S Washington St
Grand Forks, ND 58201-5766

Phone

(701) 205-3000

Fax

(701) 732-2501

NPI assigned

Oct 10, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AK, MT, ND, MN, TX, ME6 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 6

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Peterson Medical Clinics LLCGroup PAC ID 9335412220, 91 clinicians

Kenaitze Indian TribeGroup PAC ID 4082506225, 29 clinicians

Bristol Bay Area Health CorporationGroup PAC ID 5890699920, 114 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sanford Medical Center Fargo Hospital, Fargo, ND, CCN 350011
• Bristol Bay Dba Kanakanak Hospital Hospital, Dillingham, AK, CCN 021309

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dolores.vanbourgondien@chs1.eclinicaldirectplus.com
• Direct secure messaging: divanbourgondien@direct.nshcorp.org

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.

• Peterson Medical Clinics, LLC

  • Multi-Specialty Clinic/Center
  • Grand Forks, ND
  • NPI 1699295774

  AK, ME, MN, MT

  Medicare reassignment Care Compare group NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Aleknagik North, AK
  • NPI 1235291246

  TX

  Medicare reassignment Care Compare group NPD
• Kenaitze Indian Tribe

  • Federally Qualified Health Center (FQHC)
  • Kenai, AK
  • NPI 1932114600
  Medicare reassignment Care Compare group NPD
• Open Door Wellness LLC,

  • Psychiatric/Mental Health Nurse Practitioner
  • Rockland, ME
  • NPI 1841079407

  Adult Health

  Medicare reassignment NPD Authorized official
• Norton Sound Health Corporation

  • Critical Access Hospital
  • Nome, AK
  • NPI 1154358232
  Medicare reassignment NPD
• Norton Sound Health Corporation

  • Critical Access Hospital
  • Nome, AK
  • NPI 1225101041
  Medicare reassignment NPD
• Eastern Aleutian Tribes, Inc

  • Community Health Clinic/Center
  • King Cove, AK
  • NPI 1649332446

  TX

  Medicare reassignment NPD (past)
• Municipality of Skagway

  • Federally Qualified Health Center (FQHC)
  • Skagway, AK
  • NPI 1063574200
  Medicare reassignment
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Koliganek, AK
  • NPI 1013079607
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Ekwok, AK
  • NPI 1104988799
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Pilot Point, AK
  • NPI 1174683825
  NPD
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Platinum, AK
  • NPI 1285796870
  NPD

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

• Sanford Medical Center Fargo

  • Family Medicine Physician
  • West Fargo, ND
  • NPI 1184917924

  Hospital

  Care Compare affiliation
• Sanford Medical Center Fargo

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1245519081
  Care Compare affiliation
• Sanford Medical Center Fargo

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1528009412
  Care Compare affiliation
• Sanford Medical Center Fargo

  • Air Ambulance
  • Fargo, ND
  • NPI 1942415468

  Hospital

  Care Compare affiliation
• Bristol Bay Area Health Corporation

  • Clinic/Center
  • Togiak, AK
  • NPI 1093877680

  Hospital

  Care Compare affiliation
• Bristol Bay Area Health Corporation

  • Critical Access Hospital
  • Dillingham, AK
  • NPI 1831270842
  Care Compare affiliation
• Bristol Bay Area Health Corporation

  • Critical Access Hospital
  • Dillingham, AK
  • NPI 1962688309
  Care Compare affiliation
• Sanford Health of Northern Minnesota

  • Ambulatory Surgical Clinic/Center
  • Bemidji, MN
  • NPI 1093876922

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1381363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769472000000",
    "number": "1457788390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5210",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582065210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3674 S WASHINGTON ST",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582015766",
            "telephone_number": "701-205-3000",
            "fax_number": "701-732-2501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "508 Upland St",
            "address_purpose": "LOCATION",
            "city": "Kenai",
            "state": "AK",
            "postal_code": "996118026",
            "country_code": "US",
            "telephone_number": "907-335-7500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN BOURGONDIEN",
        "first_name": "DOLORES",
        "middle_name": "I",
        "credential": "ANP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-10",
        "last_updated": "2026-01-27",
        "certification_date": "2026-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "ARNP9239798",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ND",
            "license": "R54243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1695195",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010140700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Psychiatric/Mental Health Nurse Practitioner in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.