NPIMap

Individual provider Active NPI

Pedro G Mendoza, M.D. FCCP

  • Pulmonary Disease Physician
  • Bismarck, ND
National Provider Identifier
1609825132
Registry record updated Jan 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
5553 Issued in ND
Practice address
300 W Century Ave
Bismarck, ND 58503-1401
Phone
(701) 323-9900
Fax
(701) 323-9911
NPI assigned
May 10, 2006
Last updated
Jan 5, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 5, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 5553 ND Primary

Addresses

Primary practice location

300 W Century Ave
Bismarck, ND 58503-1401

Mailing address

300 W Century Ave
Bismarck, ND 58503-1401
Phone (701) 323-9900

Other identifiers 4

IdentifierTypeStateIssuer
22774OtherNDBCBS OF ND
12293OtherNDMEDICIAD GROUP NUMBER
N712611OtherNDMEDICARE SOLO #
15689MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
5553NDMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Yates Indian Health Service Hospital Past Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients
Pedro G. Mendoza M.D. P.C. PastSince Feb 10, 2003 Accepting new patients
Pedro G Mendoza MD PC PastSince Jul 1, 2007 Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294185600000",
    "number": "1609825132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W CENTURY AVE",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585031401",
            "telephone_number": "701-323-9900",
            "fax_number": "701-323-9911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W CENTURY AVE",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585031401",
            "telephone_number": "701-323-9900",
            "fax_number": "701-323-9911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "PEDRO",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D. FCCP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-10",
        "last_updated": "2011-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "ND",
            "license": "5553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ND",
            "identifier": "22774",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICIAD GROUP NUMBER",
            "identifier": "12293",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE SOLO #",
            "identifier": "N712611",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15689",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bismarck, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.