David J Pengilly, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

6620 Issued in ND

Practice address

1040 Tacoma Avenue South
Bismarck, ND 58504

Phone

(701) 323-6990

Fax

(701) 323-6994

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of North Dakota School of Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sanford BismarckGroup PAC ID 9739098575, 562 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sanford Home Care - HHA Home health agency, Mandan, ND, CCN 357029
• Sanford Medical Center Bismarck Hospital, Bismarck, ND, CCN 350015
• CHI St Alexius Health Hospital, Bismarck, ND, CCN 350002

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Sanford Bismarck

  dba Family Wellness

  • Multi-Specialty Clinic/Center
  • Bismarck, ND
  • NPI 1811941172

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Medcenter One Health Systems DME

  • Durable Medical Equipment & Medical Supplies
  • Bismarck, ND
  • NPI 1629113253
  NPD
• Sanford Bismarck

  dba Sanford Laboratory Bismarck

  • Clinical Medical Laboratory
  • Bismarck, ND
  • NPI 1154485944
  NPD
• Sanford Bismarck

  dba Sanford East Dickinson Clinic

  • Multi-Specialty Clinic/Center
  • Dickinson, ND
  • NPI 1720075377
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Sanford Bismarck

  dba Sanford MRI Center

  • General Acute Care Hospital
  • Bismarck, ND
  • NPI 1538245634
  Care Compare affiliation
• Sanford Bismarck

  dba Sanford Home Care

  • Home Health Agency
  • Mandan, ND
  • NPI 1669555744
  Care Compare affiliation
• St. Alexius Medical Center

  dba CHI St. Alexius Health

  • General Acute Care Hospital
  • Bismarck, ND
  • NPI 1306832654
  Care Compare affiliation

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294704000000",
    "number": "1710099114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5501",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585065501",
            "telephone_number": "701-323-6000",
            "fax_number": "701-323-5709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 TACOMA AVENUE SOUTH",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "58504",
            "telephone_number": "701-323-6990",
            "fax_number": "701-323-6994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENGILLY",
        "first_name": "DAVID",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2011-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "6620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17617",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roger Morris Peet, LAC
• Emma Pelach, LMSW
• Allison Evelyn Peltier, D.N.P, FNP-C
• Pelvic Flow PT
• Danette Pengilly, GNP-C
• Jeremiah Jon Penn, MD
• Alvonne Penola
• Kaitlyn Marie Perez, DNP, NP-C
• Jenny Marie Perezchica, LPCC
• Elizabeth M Perius, FNP-BC, PHD

• Family Medicine Physician in Bismarck, ND
• Providers in Bismarck, ND by specialty
• Family Medicine Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.