Ender G Raghib, M.D.
Individual provider Active NPI Pediatrics Physician · Fargo, ND
NPI 1629155643 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1629155643
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 9514 (ND)
- Practice address
- 3290 20TH St S Ste a
Fargo, ND 58104-5923 - Phone
- (701) 478-4722
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 8
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 |
|---|---|---|---|---|
| I20040107000723 | ND | Practitioner - Pediatric Medicine | 6709785850 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9514 | ND | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pinnacle Health Care, PLLC | Pediatrics | Current | Accepting new patients |
| McKenzie County Healthcare Systems Inc | Current |
Accepting new patients | |
| McKenzie County Healthcare Systems Inc | Pediatrics | Current | Accepting new patients |
| McKenzie County Healthcare Systems Inc | Current |
Accepting new patients | |
| McKenzie County Healthcare Systems Inc | Pediatrics | Past | Accepting new patients |
| McKenzie County Healthcare Systems Inc | Past | Accepting new patients | |
| Pediatric Arts Clinic | Past | Accepting new patients | |
| McKenzie County Healthcare Systems Inc | Past | Accepting new patients |
Locations
1002 18th Ave SE
Ste C
Minot, ND 58701
Phone (701) 857-6010
525 N Main St
Watford City, ND 58854
Phone (701) 842-3771
709 4th Ave NE
Watford City, ND 58854
Phone (701) 444-2331
1542 16th St W
Ste 300
Williston, ND 58801
Phone (701) 572-2470
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 9514 | ND | Yes |
Addresses
Primary practice location
3290 20TH St S Ste a
Fargo, ND 58104-5923
Mailing address
325 Edgewater Dr
West Fargo, ND 58078-4248
Phone (701) 364-2647
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 395461700 | Medicaid | MN | |
| 12730 | Medicaid | ND |
Other providers in Fargo, ND
- Tiffany Radke
- Ashlee Lianne Radtke
- Wallace E Radtke
- Emily Raftevold
- John J Ragan
- Erica Raguse
- Fnu Raheel Mohamed
- Ambika Rai
- Bina Rai
- Danny Rai
All providers in Fargo, 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 Jul 8, 2007. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.