Nevin Gillis, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

19747 Issued in ND

Practice address

128 Foussard Ave NW
St John, ND 58369

Phone

(701) 477-3111

NPI assigned

Apr 5, 2021

Last updated

Sep 6, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ND, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

General Practice

Education

University of North Dakota School of Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Spirit Lake TribeGroup PAC ID 2466550801, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Spirit Lake Tribe

  dba Spirit Lake Health Center

  • Health Service Clinic/Center
  • Fort Totten, ND
  • NPI 1114472891

  TX

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1617580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693958400000",
    "number": "1639758980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 MAIN ST",
            "city": "TURTLE LAKE",
            "state": "ND",
            "postal_code": "585754001",
            "telephone_number": "877-609-3577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 FOUSSARD AVE NW",
            "city": "ST JOHN",
            "state": "ND",
            "postal_code": "58369",
            "telephone_number": "701-477-3111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIS",
        "first_name": "NEVIN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-05",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "ND",
            "license": "19747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heavenlee M Belgarde
• Melissa Berginski
• Joyce M Delorme
• Kevin Matthew Eller
• Julie Ann Harviell
• Cleo Keplin
• Northland Health Centers
• Erica B Rosenberg
• Weston Vincent Wilkie

• General Practice Physician in Saint John, ND
• Providers in Saint John, ND by specialty
• General Practice Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.