Alex Michael Boreen, PA-C
Individual provider Active NPI Physician Assistant · Wahpeton, ND
NPI 1700512399 · NPPES record last updated Aug 7, 2024
Key facts
- NPI
- 1700512399
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PAC1082 (ND)
- Practice address
- 275 11TH St S
Wahpeton, ND 58075-4655 - Phone
- (701) 642-2000
- NPI assigned
- Jul 27, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Innovis Health LLC
Practice addresses (Care Compare)
208 Oppegard Ave NW
Twin Valley, MN 56584-4038
Phone (218) 584-5181
275 11TH St S
Wahpeton, ND 58075-4655
Phone (701) 642-2000
3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000
3902 13TH Ave S
Suite 3704
Fargo, ND 58103-7512
Phone (701) 364-6600
4110 51St Ave S
Fargo, ND 58104-7776
Phone (701) 364-3100
501 Main Ave S
Hankinson, ND 58041-4108
Phone (701) 242-7118
615 Durum Dr
Breckenridge, MN 56520-1027
Phone (701) 642-2000
Hospital & facility affiliations
- Essentia Health
- St Francis Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ND, MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240822001693 | ND | Practitioner - Physician Assistant | 2769921717 | Reassigns benefits to 1 organization |
| I20241114002557 | MN | Practitioner - Physician Assistant | 2769921717 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PAC1082 | ND | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innovis Health LLC | Current |
Accepting new patients | |
| Innovis Health LLC | Current |
Accepting new patients | |
| Innovis Health, LLC | Current |
Accepting new patients | |
| Innovis Health, LLC | Past | Accepting new patients |
Locations
400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364
208 Oppegard Ave NW
Twin Valley, MN 56584
Phone (218) 584-5181
3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000
275 11th St S
Wahpeton, ND 58075
Phone (701) 642-2000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PAC1082 | ND | Yes |
Addresses
Primary practice location
275 11TH St S
Wahpeton, ND 58075-4655
Mailing address
400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364
NPI Registry JSON
{
"created_epoch": "1658880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722988800000",
"number": "1700512399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 E 3RD ST",
"city": "DULUTH",
"state": "MN",
"postal_code": "558051951",
"telephone_number": "218-786-8364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "275 11TH ST S",
"city": "WAHPETON",
"state": "ND",
"postal_code": "580754655",
"telephone_number": "701-642-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOREEN",
"first_name": "ALEX",
"middle_name": "MICHAEL",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-27",
"last_updated": "2024-08-07",
"certification_date": "2024-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ND",
"license": "PAC1082",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wahpeton, ND
- Tracy Lynn Bjugstad
- Rhiannon Skye Blatchford
- Alicia Lynn Blaufuss
- Zachary Bohn
- Simon Michael Bolls
- Cara Noelle Brake
- Justine Braun
- Lisa R. Braun
- Heather Alison Brekke
- Grant David Brendemuhl
All providers in Wahpeton, ND · Physician Assistant in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.