Donald R. Gullicks, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Moorhead, MN
NPI 1619288602 · NPPES record last updated Oct 22, 2014
Key facts
- NPI
- 1619288602
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- TP107788 (MN)
- Practice address
- 4000 28TH Ave S
Moorhead, MN 56560-7926 - Phone
- (701) 234-3200
- Fax
- (701) 234-3239
- NPI assigned
- Jun 24, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 19
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- University of North Dakota School of Medicine, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sanford Medical Center Fargo
Sanford Health Network North
Practice addresses (Care Compare)
1220 Sheyenne St
West Fargo, ND 58078-2637
Phone (701) 234-4445
1412 Main St
Hawley, MN 56549
Phone (218) 483-3564
4000 28TH Ave S
Moorhead, MN 56560-7926
Phone (701) 234-3200
600 1St St SE
Mayville, ND 58257-1518
Phone (701) 788-4500
Hospital & facility affiliations
- Sanford Medical Center Fargo
- Sanford Mayville
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.22 of 100
- Quality
- 90.28
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 72.7
Merit-based Incentive Payment System (MIPS)
- Final score
- 82.73 of 100
- Quality
- 71.75
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 70.68
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Skin biopsy | 1-10 |
| Removal of the uterus | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ND, MN
- 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 |
|---|---|---|---|---|
| I20140919001731 | ND | Practitioner - Obstetrics/Gynecology | 4183851041 | Reassigns benefits to 2 organizations |
| I20140929000960 | MN | Practitioner - Obstetrics/Gynecology | 4183851041 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TP107788 | MN | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sanford Medical Center Fargo | Obstetrics & Gynecology | Current |
Accepting new patients |
| Sanford Medical Center Fargo | Current |
Accepting new patients | |
| Sanford Health Network North | Current |
Accepting new patients | |
| Sanford Medical Center Fargo | Past | Accepting new patients |
Locations
4000 28th Ave S
Moorhead, MN 56560
Phone (701) 234-3200
2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800
5225 23rd Ave S
Fargo, ND 58104
Phone (701) 234-5933
801 Broadway N
Fargo, ND 58102
Phone (701) 234-5121
407 Washington Ave E
Finley, ND 58230
Phone (701) 524-1005
42 6th Ave SE
Mayville, ND 58257
Phone (701) 786-3800
600 1st St SE
Mayville, ND 58257
Phone (701) 786-4500
1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 2010020741 | MO | |
| Obstetrics & Gynecology Physician | 207V00000X | TP107788 | MN | Yes |
| Obstetrics & Gynecology Physician | 207V00000X | 13170 | ND |
Addresses
Primary practice location
4000 28TH Ave S
Moorhead, MN 56560-7926
Mailing address
PO Box 2168
Fargo, ND 58107-2168
Phone (701) 234-2119
Other providers in Moorhead, MN
- Brooke Gronwold
- Callie Grosz
- Nicole Groves
- Ashley Rae Guenther
- Shelley Guida
- Katie A Gurskis
- Erin Gustafson
- Grace Gutterud
- Haley Jo Hadrava
- Hagel-Boyd Pharmacy Inc
All providers in Moorhead, MN · Obstetrics & Gynecology Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2014. 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.