NPIMap

Organization Active NPI

Minot Health Clinic, PLLC

  • Primary Care Clinic/Center
  • Minot, ND
National Provider Identifier
1477970846
Registry record updated Feb 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
R30827 Issued in ND
Legal business name
MINOT HEALTH CLINIC, PLLC
Practice address
1021 20TH Ave SW Ste 113
Minot, ND 58701-6487
Phone
(701) 837-1551
NPI assigned
Mar 24, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2021

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

Authorized official

Name
Trisha Fennern, FNP-CNPI 1013220490
Title
Owner/Practitioner
Phone
(701) 837-1551

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X R30827 ND Primary

Addresses

Primary practice location

1021 20TH Ave SW Ste 113
Minot, ND 58701-6487

Mailing address

1021 20TH Ave SW Ste 113
Minot, ND 58701-6487
Phone (701) 837-1551

Other identifiers 3

IdentifierTypeStateIssuer
715283OtherNDMEDICARE
1013220490OtherNDBCBS
84015MedicaidND

Other names 1

  • Minot Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140918001951 ND Part B Supplier - Clinic/Group Practice 0143449439 Receives reassigned benefits from 7 practitioners
Practice locations: Minot, ND

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
35D2078988Minot Health Clinic1021 20TH Ave SW Suite 113, Minot, ND 58701Certificate of waiverJun 8, 2028

National Provider Directory

National Provider Directory

Locations

1021 20th Ave SW
Ste 113
Minot, ND 58701
Phone (701) 837-1551

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22649/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1395619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612742400000",
    "number": "1477970846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 20TH AVE SW STE 113",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587016487",
            "telephone_number": "701-837-1551",
            "fax_number": "701-837-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 20TH AVE SW STE 113",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587016487",
            "telephone_number": "701-837-1551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINOT HEALTH CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-24",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A",
        "authorized_official_last_name": "FENNERN",
        "authorized_official_first_name": "TRISHA",
        "authorized_official_title_or_position": "OWNER/PRACTITIONER",
        "authorized_official_telephone_number": "701-837-1551",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "ND",
            "license": "R30827",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "715283",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1013220490",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "84015",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minot Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minot, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.