NPIMap

Organization Active NPI

Mercy Medical Center

Doing business as CHI St Alexius Health Williston

  • Emergency Medicine Physician
  • Williston, ND
National Provider Identifier
1720194624
Registry record updated Nov 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
5052A Issued in ND
Legal business name
MERCY MEDICAL CENTER
Doing business as
CHI St Alexius Health Williston
Practice address
1301 15TH Ave W
Williston, ND 58801-3821
Phone
(701) 774-7400
Fax
(701) 774-7479
NPI assigned
Aug 22, 2006
Last updated
Nov 17, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2016

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

Authorized official

Name
Joseph Ruark
Title
VP-Operational Finance
Phone
(701) 774-7400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 5052A ND Primary

Addresses

Primary practice location

1301 15TH Ave W
Williston, ND 58801-3821

Mailing address

1301 15TH Ave W
Williston, ND 58801-3821
Phone (701) 774-7400

Other identifiers 3

IdentifierTypeStateIssuer
000142001OtherNDBLUE CROSS OF ND
13671MedicaidND
402272MedicaidMT

Other names 1

  • CHI St Alexius Health Williston Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031230000336 ND Part B Supplier - Clinic/Group Practice 7416851381 Receives reassigned benefits from 288 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Williston, ND; Tioga, ND

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 54

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 54

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479340800000",
    "number": "1720194624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 15TH AVE W",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588013821",
            "telephone_number": "701-774-7400",
            "fax_number": "701-774-7479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 15TH AVE W",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588013821",
            "telephone_number": "701-774-7400",
            "fax_number": "701-774-7479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2016-11-17",
        "status": "A",
        "authorized_official_last_name": "RUARK",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "VP-OPERATIONAL FINANCE",
        "authorized_official_telephone_number": "701-774-7400"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ND",
            "license": "5052A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ND",
            "identifier": "000142001",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "13671",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "402272",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHI St Alexius Health Williston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williston, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.