NPIMap

Individual provider Active NPI

Michael John Lillestol, M.D.

  • Internal Medicine Physician
  • Fargo, ND
National Provider Identifier
1669427688
Registry record updated Aug 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4830 Issued in ND
Practice address
1707 Gold Dr
Ste 101
Fargo, ND 58103-6413
Phone
(701) 280-2033
Fax
(701) 232-5578
NPI assigned
May 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4830 ND Primary

Addresses

Primary practice location

1707 Gold Dr
Ste 101
Fargo, ND 58103-6413

Mailing address

1707 Gold Dr
Ste 101
Fargo, ND 58103-6413
Phone (701) 280-2033

Other identifiers 10

IdentifierTypeStateIssuer
D26082OtherNDND WORKERS COMP
14165MedicaidND
162D9LIOtherNDMINNESOTA BLUE SHIELD
21574OtherNDND BLUE SHIELD
1008297OtherPREFERRED ONE
116742OtherUCARE
04-12025OtherMEDICA
663288200MedicaidMN
ND4830OtherCHAMPUS
141875400OtherFEDERAL WORKERS COMP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101022000179 ND Practitioner - Internal Medicine 3577662634 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of North Dakota School of Medicine, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Internal Medicine Associates IncGroup PAC ID 8527027879, 13 clinicians

Practice addresses (Care Compare)

4450 31St Ave S
Suite 102
Fargo, ND 58104-4557
Phone (701) 280-2033

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
62.19 of 100Reported as individual
Quality
96.53
Promoting interoperability
0
Improvement activities
40
Cost
60.77

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4830NDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Internal Medicine Associates Inc Internal Medicine CurrentSince Feb 1, 2002 Accepting new patients
Paracelsus Healthcare Corp Past Accepting new patients

Locations

4450 31st Ave S
Ste 102
Fargo, ND 58104
Phone (701) 280-2033

1707 Gold Dr S
Ste 101
Fargo, ND 58103
Phone (701) 280-2033

100 4th St S
Ste 604
Fargo, ND 58103

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Hia HospiceFargo, ND, CCN 351500 Hospice Corporate Director Jun 20, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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 10

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": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282867200000",
    "number": "1669427688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1707 GOLD DR",
            "address_2": "STE 101",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036413",
            "telephone_number": "701-280-2033",
            "fax_number": "701-232-5578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 GOLD DR",
            "address_2": "STE 101",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036413",
            "telephone_number": "701-280-2033",
            "fax_number": "701-232-5578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLESTOL",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2010-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ND",
            "license": "4830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND WORKERS COMP",
            "identifier": "D26082",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14165",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MINNESOTA BLUE SHIELD",
            "identifier": "162D9LI",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND BLUE SHIELD",
            "identifier": "21574",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1008297",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "116742",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "04-12025",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "663288200",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "ND4830",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL WORKERS COMP",
            "identifier": "141875400",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.