Innovis Health LLC
Organization Active NPI Family Medicine Physician · Moorhead, MN
NPI 1659617504 · NPPES record last updated Mar 1, 2024
Key facts
- NPI
- 1659617504
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- INNOVIS HEALTH LLC
- Practice address
- 801 Belsly Blvd
Moorhead, MN 56560-5055 - Phone
- (701) 364-6800
- Fax
- (701) 364-6828
- NPI assigned
- Dec 21, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- ESSENTIA HEALTH
Authorized official
- Name
- Alan J Hurley
- Title
- Coo
- Phone
- (701) 364-7667
Owned or controlled facilities with NPI records 24
Other NPIs on the same Medicare enrollment 25
Other NPIs with the same Medicare PAC ID 6
Practitioners 598
-
Michelle L Carl, APRN,CNP
-
Katie A Gurskis, NP-C
-
Hope E. Meyer, M.D.
-
Loni Shannon Muus, APRN, CNP
-
Angela Marie Skyberg, PA-C
-
Monica Sue Wenschlag, DNP
-
Marwan M.B. Abu Minshar, M.D.
-
Megan Laurel Ahern, FNP-BC
-
Amy Michelle Allard, FNP-C
-
Marin Almer, AUD
-
Elisha D Anderson, NP-C
-
Brooke A Badjie, APRN,CNP
-
Aftin E Bye, APRN, CNP
-
Dennis Nyagechanga Chakua, FNP-C
-
Jordan J Coplin, APRN, CNP
-
Dawn L Deal-Dahle, PA-C
-
Kylie Engebretson, PA-C
-
John K Erie, MD
-
Michelle Franek, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ND, MN
All facility ownership & control disclosures 24
| Facility | Type | Role | Since |
|---|---|---|---|
| Essentia Health St Mary'S Detroit Lakes |
Hospital | Operational/Managerial Control | Jan 1, 2017 |
| Essentia Health Fosston |
Hospital | Operational/Managerial Control | Jan 1, 2017 |
| Essentia Health Ada |
Hospital | Operational/Managerial Control | Jan 1, 2017 |
| Essentia Health Fosston |
Hospital | Operational/Managerial Control | Jan 1, 2017 |
| Essentia Health Holy Trinity Hospital |
Hospital | Operational/Managerial Control | Jan 1, 2017 |
| Essentia Health Holy Trinity Hospital |
Hospital | Operational/Managerial Control | Jan 1, 2017 |
| Essentia Health Ada |
Hospital | Operational/Managerial Control | Jan 1, 2017 |
| Essentia Health - Oak Crossing |
Skilled nursing facility | Operational/Managerial Control Adp of the SNF |
Jan 1, 2017 Jan 29, 2025 |
| Essentia Health Grace Home |
Skilled nursing facility | Operational/Managerial Control Adp of the SNF |
Jan 1, 2017 Jan 29, 2025 |
| Essentia Health First Care Living Center |
Skilled nursing facility | Operational/Managerial Control Adp of the SNF |
Jan 1, 2017 Jan 29, 2025 |
| Essentia Health Home Care West |
Home health agency | Operational/Managerial Control | Jan 1, 2011 |
| Essentia Health Home Care Graceville |
Home health agency | Operational/Managerial Control | Jan 1, 2011 |
| Essentia Health Hospice West |
Hospice | Operational/Managerial Control (100%) | Jan 1, 2011 |
| Essentia Health Ada Clinic |
Rural health clinic | Operational/Managerial Control | Jan 1, 2017 |
| Essentia Health Graceville Clinic |
Rural health clinic | Operational/Managerial Control | Jan 1, 2017 |
| Essentia Health Oklee Clinic |
Rural health clinic | Operational/Managerial Control | Jan 1, 2017 |
| Essentia Health Bagley Clinic |
Rural health clinic | Operational/Managerial Control | Jan 1, 2017 |
| Essentia Health St Mary'S Mahnomen Clinic |
Rural health clinic | Operational/Managerial Control | Jan 1, 2017 |
| Essentia Health St Mary'S Pelican Rapids Clinic |
Rural health clinic | Operational/Managerial Control | Jan 1, 2017 |
| Essentia Health Park Rapids Clinic |
Rural health clinic | Operational/Managerial Control | Jan 1, 2017 |
| Essentia Health Menahga Clinic |
Rural health clinic | Operational/Managerial Control | Jan 1, 2017 |
| Essentia Health Walker Clinic |
Rural health clinic | Operational/Managerial Control | Jan 1, 2017 |
| Essentia Health St. Mary'S Frazee Clinic |
Rural health clinic | Operational/Managerial Control | Apr 1, 2019 |
| Essentia Health Park Rapids Hwy 34 Clinic |
Rural health clinic | Operational/Managerial Control | Aug 17, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071211000158 | ND | Part B Supplier - Clinic/Group Practice | 9931298155 |
Receives reassigned benefits from 693 practitioners 22 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Jamestown, ND; West Fargo, ND; Wahpeton, ND; Valley City, ND; Lisbon, ND; Hankinson, ND; Fargo, ND; Bismarck, ND… |
| O20080115000831 | MN | Part B Supplier - Clinic/Group Practice | 9931298155 |
Receives reassigned benefits from 108 practitioners 12 other NPIs on this enrollment Practice locations: Fergus Falls, MN; Wheaton, MN; Ulen, MN; Twin Valley, MN; Thief River Falls, MN; Park Rapids, MN; Moorhead, MN; Duluth, MN… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
801 Belsly Blvd
Moorhead, MN 56560-5055
Mailing address
PO Box 1450 Nw7813
Minneapolis, MN 55485-7813
Phone (701) 364-3300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14510 | Medicaid | ND |
Other names
- Essentia Health Moorhead Clinic
NPI Registry JSON
{
"created_epoch": "1356048000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1709251200000",
"number": "1659617504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1450 NW7813",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554857813",
"telephone_number": "701-364-3300",
"fax_number": "701-364-8906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 BELSLY BLVD",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565605055",
"telephone_number": "701-364-6800",
"fax_number": "701-364-6828"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INNOVIS HEALTH LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ESSENTIA HEALTH",
"enumeration_date": "2012-12-21",
"last_updated": "2024-03-01",
"certification_date": "2024-03-01",
"status": "A",
"authorized_official_last_name": "HURLEY",
"authorized_official_first_name": "ALAN",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "COO",
"authorized_official_telephone_number": "701-364-7667"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "14510",
"state": "ND"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Essentia Health Moorhead Clinic",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Essentia Health Moorhead Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Moorhead, MN
- Fadumo Ibrahim
- Fardowsa M Ibrahim
- Ramla Ali Ibrahim
- Ind School Dist 152
- Innovis Health LLC
- Insight Care LLC
- Integrated Counseling Services
- Integrity Care Services Inc
- Integrix Health, LLC
- Chelsea Irmen
All providers in Moorhead, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2024. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.