NPIMap

Organization Active NPI

Spectra Health

  • Federally Qualified Health Center (FQHC)
  • Grand Forks, ND
National Provider Identifier
1689878324
Registry record updated Jul 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SPECTRA HEALTH
Practice address
212 S 4TH St
Suite 101
Grand Forks, ND 58201-4777
Phone
(701) 757-2100
Fax
(701) 757-2103
NPI assigned
Jun 14, 2007
Last updated
Jul 10, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2019

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

Authorized official

Name
Ben Shannon
Title
Operations Manager
Phone
(701) 757-2812

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

212 S 4TH St
Suite 101
Grand Forks, ND 58201-4777

Mailing address

212 S 4TH St Ste 200
Grand Forks, ND 58201-4781
Phone (701) 757-2100

Other identifiers 2

IdentifierTypeStateIssuer
5910MedicaidND
1689878324MedicaidMN

National Provider Directory

National Provider Directory
Tax ID family
Valley Community HLTH CTRS4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

212 S 4th St
Ste 101
Grand Forks, ND 58201
Phone (701) 412-3600

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562716800000",
    "number": "1689878324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 S 4TH ST STE 200",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014781",
            "telephone_number": "701-757-2100",
            "fax_number": "701-757-2103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 S 4TH ST",
            "address_2": "SUITE 101",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014777",
            "telephone_number": "701-757-2100",
            "fax_number": "701-757-2103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRA HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-14",
        "last_updated": "2019-07-10",
        "status": "A",
        "authorized_official_last_name": "SHANNON",
        "authorized_official_first_name": "BEN",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "701-757-2812"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5910",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689878324",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.