Individual provider Active NPI

Bradley William Kohoutek, M.D.

  • Psychiatry Physician
  • Fargo, ND
National Provider Identifier
1649406703
Registry record updated Jun 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
12317 Issued in ND
Practice address
1717 University Dr S
Fargo, ND 58103-4939
Phone
(701) 234-2000
NPI assigned
Jun 3, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 5, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X 12317 ND Primary

Addresses

Primary practice location

1717 University Dr S
Fargo, ND 58103-4939

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-9419

Other identifiers 1

IdentifierTypeStateIssuer
17034MedicaidND

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20121011000917 ND Practitioner - Psychiatry 4688823388 Reassigns benefits to 1 organization
I20200529002623 MN Practitioner - PsychiatryPractitioner - Neurology 4688823388 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of North Dakota School of Medicine, 2009
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

1711 University Dr S
Fargo, ND 58103-4939
Phone (701) 417-5710

1717 University Dr S
Fargo, ND 58103-4939
Phone (701) 234-2000

4840 23Rd Ave S
Fargo, ND 58104-9136
Phone (701) 417-6999

5225 23Rd Ave S
Fargo, ND 58104-7927
Phone (701) 417-2575

801 Broadway N
Fargo, ND 58102-3641
Phone (701) 234-2000

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 Medicine

State licenses

LicenseStateTypeSpecialty
1783MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health of Northern Minnesota Current Accepting new patients
Sanford Medical Center Fargo CurrentSince Jul 22, 2013 Accepting new patients
Sanford Health of Northern Minnesota CurrentSince Mar 1, 2020 Accepting new patients
Sanford Health of Northern Minnesota CurrentSince Mar 1, 2020 Accepting new patients
Sanford Medical Center Fargo CurrentSince Jul 22, 2013 Accepting new patients

Locations

1400 Highway 71
Intl Falls, MN 56649
Phone (218) 283-4481

1717 University Dr S
Fargo, ND 58103
Phone (701) 234-2305

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

100 4th St S
Fargo, ND 58103
Phone (701) 234-4141

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

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1243987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780617600000",
    "number": "1649406703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-9419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034939",
            "telephone_number": "701-234-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOHOUTEK",
        "first_name": "BRADLEY",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-03",
        "last_updated": "2026-06-05",
        "certification_date": "2026-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ND",
            "license": "12317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17034",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.