Individual provider Active NPI

Alex Michael Boreen, PA-C

  • Physician Assistant
  • Wahpeton, ND
National Provider Identifier
1700512399
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PAC1082 Issued in ND
Practice address
275 11TH St S
Wahpeton, ND 58075-4655
Phone
(701) 642-2000
NPI assigned
Jul 27, 2022
Last updated
Aug 7, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

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 PAC1082 ND Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240822001693 ND Practitioner - Physician Assistant 2769921717 Reassigns benefits to 1 organization
I20241114002557 MN Practitioner - Physician Assistant 2769921717 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Innovis Health LLCGroup PAC ID 9931298155, shared by 7 NPIs, 561 clinicians

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PAC1082NDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Innovis Health, LLC CurrentSince Aug 26, 2024 Accepting new patients
Innovis Health LLC CurrentSince Aug 26, 2024 Accepting new patients
Innovis Health LLC CurrentSince Nov 11, 2024 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) 364-4222

275 11th St S
Wahpeton, ND 58075
Phone (701) 642-2000

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "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

Sources for this page

Verify at the official NPI Registry.