Active NPI
Michael August Yeradi
- Surgery Physician
- Grand Forks, ND
National Provider Identifier
1538817689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- RL21252
- Practice address
- 1301 N Columbia Rd Stop 9037
Grand Forks, ND 58202-9037 - Phone
- (701) 777-2514
- NPI assigned
- Mar 16, 2022
- Last updated
- Aug 28, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | RL21252 | ND | Primary |
Addresses
Primary practice location
1301 N Columbia Rd Stop 9037
Grand Forks, ND 58202-9037
Mailing address
1301 N Columbia Rd Stop 9037
Grand Forks, ND 58202-9037
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230727003340 | NE | Order and Referring Only - General Surgery | 4082075700 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9740 | NE | MD | Mental Health Counselor |
| RL21252 | ND | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724803200000",
"number": "1538817689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1301 N COLUMBIA RD STOP 9037",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582029037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 N COLUMBIA RD STOP 9037",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582029037",
"telephone_number": "701-777-2514"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YERADI",
"first_name": "MICHAEL",
"middle_name": "AUGUST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-03-16",
"last_updated": "2024-08-28",
"certification_date": "2024-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "ND",
"license": "RL21252",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Forks, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.