Myra J Quanrud, MD
Individual provider Active NPI Pediatrics Physician · Jamestown, ND
NPI 1598705758 · NPPES record last updated Aug 29, 2011
Key facts
- NPI
- 1598705758
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 70000 (ND)
- Practice address
- 401 3Rd St SE
Jamestown, ND 58401-4247 - Phone
- (701) 253-5300
- Fax
- (701) 253-5402
- NPI assigned
- Jun 7, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Pediatric Medicine
- Education
- University of North Dakota School of Medicine, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Anne Carlsen Center
Practice addresses (Care Compare)
701 3Rd St NW
Jamestown, ND 58401-2963
Phone (701) 252-3850
Hospital & facility affiliations
- Jamestown Regional Medical Center
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 |
|---|---|---|---|---|
| I20071211000020 | ND | Practitioner - Pediatric Medicine | 4981793197 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 70000 | ND | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innovis Health LLC | Current |
Accepting new patients | |
| Anne Carlsen Center | Current |
Accepting new patients | |
| Innovis Health, LLC | Current | Accepting new patients | |
| Innovis Health LLC | Current |
Accepting new patients | |
| Anne Carlsen Center | Past | Accepting new patients |
Locations
3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000
2430 20th St SW
Jamestown, ND 58401
Phone (701) 253-5300
701 3rd St NW
Jamestown, ND 58401
Phone (701) 252-3850
2200 20th St SW
Jamestown, ND 58401
Phone (701) 252-3850
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 70000 | ND | Yes |
Addresses
Primary practice location
401 3Rd St SE
Jamestown, ND 58401-4247
Mailing address
401 3Rd St SE
Jamestown, ND 58401-4247
Phone (701) 253-5300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 18047 | Medicaid | ND | |
| 772827100 | Medicaid | ND | |
| ND100023 | Other | ND | LHS # |
| 12426 | Other | ND | NDBS # |
| 142318 | Other | ND | UCARE # |
| HP19572 | Other | ND | HEALTHPARTNERS # |
| 14494 | Other | ND | NDBS # |
| 370020540 | Other | ND | RR MEDICARE # |
| 00A25QU | Other | ND | MNBS # |
| 1201183 | Other | ND | MEDICA # |
| 908075 | Other | ND | AMERICA'S PPO/ARAZ # |
| 5T219QU | Other | ND | MNBS # |
| DA9061015621 | Other | ND | PREFERRED ONE # |
Other names
- Myra J Hennessey
Other providers in Jamestown, ND
- Kennedy Joe Pugh
- Robert J Purcell
- Qual Chiropractic
- Richard W Qual
- Terri Mae Qual
- Landon Rachel
- Radiology Services, P.a.
- Shamso Osman Rage
- Tim L Randall
- Madeline Ranum
All providers in Jamestown, ND · Pediatrics 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 Aug 29, 2011. 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.