NPIMap

Individual provider Active NPI

Charles C Canver, MD, MBA

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Fargo, ND
National Provider Identifier
1477855450
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
19268 Issued in ND
Practice address
3000 32ND Ave S
Fargo, ND 58103-6132
Phone
(701) 364-8000
Fax
(573) 302-2268
NPI assigned
Nov 24, 2010
Last updated
Jan 31, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 01060317A IN
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 8603 NH
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 19268 ND Primary

Addresses

Primary practice location

3000 32ND Ave S
Fargo, ND 58103-6132

Mailing address

1702 University Dr S
Fargo, ND 58103-4940

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 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
I20230208000731 ND Practitioner - Thoracic Surgery 9537484779 Reassigns benefits to 1 organization
I20241210003323 MN Practitioner - Thoracic Surgery 9537484779 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Thoracic Surgery
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Regional Health CenterGroup PAC ID 2062326820, 190 clinicians
Innovis Health LLCGroup PAC ID 9931298155, 561 clinicians

Practice addresses (Care Compare)

1027 Washington Ave
Detroit Lakes, MN 56501-3409
Phone (218) 847-5611

3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)1-10
Pacemaker insertion or repair1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Business Administration, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01060317AINMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
19268NDMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
8603NHMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Innovis Health LLC CurrentSince Feb 27, 2023 Accepting new patients
Innovis Health, LLC Current Accepting new patients
St. Marys Regional Health Center CurrentSince Dec 18, 2024 Accepting new patients
Innovis Health LLC CurrentSince Feb 27, 2023 Accepting new patients
St Mary's Regional Health Center CurrentSince Dec 18, 2024 Accepting new patients

Locations

1027 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 844-2300

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

1702 University Dr S
Fargo, ND 58103
Phone (701) 364-4222

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000

Organizations & group practices 5

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 4

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": "1290556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675123200000",
    "number": "1477855450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 32ND AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036132",
            "telephone_number": "701-364-8000",
            "fax_number": "573-302-2268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANVER",
        "first_name": "CHARLES",
        "middle_name": "C",
        "credential": "MD, MBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-24",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IN",
            "license": "01060317A",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "NH",
            "license": "8603",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "ND",
            "license": "19268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.