Individual provider Active NPI

Mariah Dawn Laver Juanto, PH.D.

  • Psychologist
  • Grand Forks, ND
National Provider Identifier
1629401567
Registry record updated Aug 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Practice address
2100 S Columbia Rd
Suite 202
Grand Forks, ND 58201-5895
Phone
(701) 772-1588
NPI assigned
Aug 14, 2013
Last updated
Aug 14, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X Primary

Addresses

Primary practice location

2100 S Columbia Rd
Suite 202
Grand Forks, ND 58201-5895

Mailing address

2100 S Columbia Rd
Suite 202
Grand Forks, ND 58201-5895
Phone (701) 772-1588

Other names 1

  • Mariah Dawn Laver Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140902002021 ND Practitioner - Clinical Psychologist 5294953352 Reassigns benefits to 1 organization
I20160209001962 MN Practitioner - Clinical Psychologist 5294953352 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

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

1720 University Dr S
Fargo, ND 58103-4940
Phone (701) 234-2000

4000 28TH Ave S
Moorhead, MN 56560-7926
Phone (701) 234-3200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.73 of 100Reported as group
Quality
71.75
Promoting interoperability
100
Improvement activities
40
Cost
70.68

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo CurrentSince Jul 14, 2014 Accepting new patients
Sanford Medical Center Fargo CurrentSince Jul 14, 2014 Accepting new patients
Family Institute, PC PastSince Nov 30, 2017 Accepting new patients

Locations

1301 8th St S
Moorhead, MN 56560
Phone (701) 234-3200

4000 28th Ave S
Moorhead, MN 56560
Phone (701) 234-3200

2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

Organizations & group practices 3

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1376438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376438400000",
    "number": "1629401567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 S COLUMBIA RD",
            "address_2": "SUITE 202",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582015895",
            "telephone_number": "701-772-1588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 S COLUMBIA RD",
            "address_2": "SUITE 202",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582015895",
            "telephone_number": "701-772-1588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAVER JUANTO",
        "first_name": "MARIAH",
        "middle_name": "DAWN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-14",
        "last_updated": "2013-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIAH",
            "last_name": "LAVER",
            "middle_name": "DAWN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.