Lydia Chardel Bruenjes, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PAC0931 Issued in ND

Practice address

4110 51St Ave S
Fargo, ND 58104-7776

Phone

(017) 364-3100

NPI assigned

Jul 31, 2018

Sex

Female

Sole proprietor

No

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.

• Innovis Health, LLC

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1215125463

  ND

  Medicare reassignment Care Compare group
• Innovis Health LLC

  • Family Medicine Physician
  • Moorhead, MN
  • NPI 1659617504

  MN

  Medicare reassignment Care Compare group
• Innovis Health, LLC.

  • Family Medicine Physician
  • Wahpeton, ND
  • NPI 1790965440
  Care Compare group NPD
• Innovis Health LLC

  • Family Medicine Physician
  • Fargo, ND
  • NPI 1255677084
  Care Compare group
• Innovis Health LLC

  • Family Medicine Physician
  • Fargo, ND
  • NPI 1578907655
  Care Compare group
• Innovis Health LLC

  • Multi-Specialty Clinic/Center
  • Fargo, ND
  • NPI 1780043257
  Care Compare group
• Innovis Health, LLC

  • Ambulatory Surgical Clinic/Center
  • Wahpeton, ND
  • NPI 1548446669
  Care Compare group
• Innovis Health LLC

  • Multi-Specialty Clinic/Center
  • Fargo, ND
  • NPI 1144776576
  NPD

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

• Innovis Health, LLC

  • General Acute Care Hospital
  • Fargo, ND
  • NPI 1215125463

  Hospital

  Care Compare affiliation

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Innovis Health LLC 561 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Essentia Health Hospital, Fargo, ND, CCN 350070

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

• Lydi Chardel Stinar Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 21, 2022.

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647820800000",
    "number": "1720566847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 51ST AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581047776",
            "telephone_number": "017-364-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUENJES",
        "first_name": "LYDIA",
        "middle_name": "CHARDEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-31",
        "last_updated": "2022-03-21",
        "certification_date": "2022-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601008509",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13972",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LYDI",
            "last_name": "STINAR",
            "middle_name": "CHARDEL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tiffany Rose Brown
• Wendy Irene Brown, PHARM.D, PA-C
• Shaunte Brownotter
• Jeremy Forrest Brudevold, D.O.
• Donald Bruenjes, ATC
• Haley Jo Bruggeman, CRNA
• Jodi Bruggeman
• Emily Brugman
• Ashley Jean Bruhn, OTR/L
• Melanie Marie Brumwell

• All providers in Fargo, ND
• Physician Assistant in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2022; 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.