NPIMap

Organization Active NPI

University of North Dakota

  • Family Medicine Physician
  • Bismarck, ND
National Provider Identifier
1619905528
Registry record updated Mar 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
UNIVERSITY OF NORTH DAKOTA
Practice address
701 E. Rosser Ave.
Bismarck, ND 58501-4461
Phone
(701) 328-9950
Fax
(701) 328-9957
NPI assigned
Jun 29, 2006
Last updated
Mar 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2023

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

Authorized official

Name
Jodi Myrvik
Title
Business Manager
Phone
(701) 751-6753

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Non-Surgical Family Planning Clinic/Center 261QF0050X

Addresses

Primary practice location

701 E. Rosser Ave.
Bismarck, ND 58501-4461

Mailing address

701 E. Rosser Ave.
Bismarck, ND 58501-4461
Phone (701) 751-9500

Other identifiers 3

IdentifierTypeStateIssuer
102001OtherNDBCBS
12083MedicaidND
1459002MedicaidND

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040204000241 ND Part B Supplier - Clinic/Group Practice 2961395934 Receives reassigned benefits from 48 practitioners
4 other NPIs on this enrollment
Practice locations: Bismarck, ND; Grand Forks, ND; Minot, ND

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Bismark Family Practice14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Practitioners & affiliated clinicians

Practitioners 48

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680134400000",
    "number": "1619905528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 E. ROSSER AVE.",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585014461",
            "telephone_number": "701-751-9500",
            "fax_number": "701-751-9508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 E. ROSSER AVE.",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585014461",
            "telephone_number": "701-328-9950",
            "fax_number": "701-328-9957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF NORTH DAKOTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A",
        "authorized_official_last_name": "MYRVIK",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "701-751-6753"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "102001",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12083",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1459002",
            "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 Mar 30, 2023; 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.

Verify at the official NPI Registry.