Jordan I Amatuegwu, M.D.
Individual provider Active NPI Family Medicine Physician · Fargo, ND
NPI 1467985291 · NPPES record last updated Jun 8, 2023
Key facts
- NPI
- 1467985291
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 16442 (ND)
- Practice address
- 2400 32ND Ave S
Fargo, ND 58103-5800 - Phone
- (701) 234-2000
- NPI assigned
- Apr 8, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sanford Medical Center Fargo
Practice addresses (Care Compare)
1220 Sheyenne St
West Fargo, ND 58078-2637
Phone (701) 234-4445
1720 University Dr S
Fargo, ND 58103-4940
Phone (701) 234-2000
2400 32ND Ave S
Fargo, ND 58103-5800
Phone (701) 234-2000
801 Broadway N
Fargo, ND 58102-3641
Phone (701) 234-2000
Hospital & facility affiliations
- Sanford Medical Center Fargo
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200814001091 | ND | Practitioner - Family Practice | 2163769597 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sanford Medical Center Fargo | Current |
Accepting new patients | |
| Innovis Health, LLC | Current | Accepting new patients | |
| Innovis Health LLC | Family Medicine | Current |
Accepting new patients |
| Sanford Medical Center Fargo | Family Medicine | Current |
Accepting new patients |
| Innovis Health, LLC. | Family Medicine | Current |
Accepting new patients |
| Sanford Medical Center Fargo | Past | Accepting new patients |
Locations
801 Broadway N
Fargo, ND 58102
Phone (701) 234-5121
1702 University Dr S
Fargo, ND 58103
Phone (701) 364-4222
2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800
4110 51st Ave S
Fargo, ND 58104
Phone (701) 364-3100
3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000
1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 16442 | ND | Yes |
Addresses
Primary practice location
2400 32ND Ave S
Fargo, ND 58103-5800
Mailing address
PO Box 5074
Sioux Falls, SD 57117-5074
Other providers in Fargo, ND
- Malak Alzidaneen
- Am Investments LLC
- Alec Michelle Aman
- Kelsey Aman
- Amare Bloom Care LLC
- Rawand Amedi
- Amedisys North Dakota LLC
- American Drug Stores Delaware LLC
- American Drug Stores Delaware LLC
- American Lutheran Homes Inc
All providers in Fargo, ND · Family Medicine Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.