NPIMap

Individual provider Active NPI

Jessica Adeline Satrom, P.A-C

  • Physician Assistant
  • Fargo, ND
National Provider Identifier
1669939658
Registry record updated Apr 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12706 Issued in MN
Practice address
4656 40TH Ave S
Fargo, ND 58104-4397
Phone
(701) 234-8860
Fax
(701) 234-8924
NPI assigned
Feb 26, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 12706 MN Primary

Addresses

Primary practice location

4656 40TH Ave S
Fargo, ND 58104-4397

Mailing address

2258 Thorndale Ave
New Brighton, MN 55112-5213
Phone (701) 799-9444

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jsatrom13513259@direct.sanfordhealth.org

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
I20190920001314 ND Practitioner - Physician Assistant 1951631746 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
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

4656 40TH Ave S
Fargo, ND 58104-4397

904 5TH Ave NE
Jamestown, ND 58401-3437
Phone (701) 253-4000

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
Physician Assistant

State licenses

LicenseStateTypeSpecialty
12706MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo CurrentSince Jul 9, 2019 Accepting new patients
Sanford Medical Center Fargo Current Accepting new patients
Sanford Medical Center Fargo CurrentSince Jul 9, 2019 Accepting new patients
Sanford Medical Center Fargo Past Accepting new patients
My Dermatologist, PA PastSince May 1, 2014 Accepting new patients

Locations

4656 40th Ave S
Fargo, ND 58104
Phone (701) 234-2431

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

904 5th Ave NE
Jamestown, ND 58401
Phone (701) 253-4000

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

Interoperability endpoints

  • Direct secure messaging: jsatrom13513259@direct.sanfordhealth.org

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": "1551139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1669939658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2258 THORNDALE AVE",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551125213",
            "telephone_number": "701-799-9444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4656 40TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044397",
            "telephone_number": "701-234-8860",
            "fax_number": "701-234-8924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SATROM",
        "first_name": "JESSICA",
        "middle_name": "ADELINE",
        "credential": "P.A-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-26",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsatrom13513259@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "4656 40th Ave S",
            "city": "Fargo",
            "state": "ND",
            "country_code": "US",
            "postal_code": "581044397",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.