NPIMap

Individual provider Active NPI

Bruce L Domm, MD

  • Family Medicine Physician
  • Casselton, ND
National Provider Identifier
1730106329
Registry record updated Oct 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5341 Issued in ND
Practice address
5 9TH Ave N
Casselton, ND 58012-3339
Phone
(701) 347-4445
Fax
(701) 347-5276
NPI assigned
Jul 17, 2006
Last updated
Oct 17, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5341 ND Primary

Addresses

Primary practice location

5 9TH Ave N
Casselton, ND 58012-3339

Mailing address

PO Box 6001
Fargo, ND 58108-6001
Phone (701) 364-3300

Other identifiers 15

IdentifierTypeStateIssuer
0108127OtherNDMEDICA #
37983OtherNDSIOUX VALLEY #
112583400MedicaidND
DA9011015505OtherNDPREFERRED ONE #
HP19507OtherNDHEALTHPARTNERS #
336OtherNDNDBS #
93416DOOtherNDMNBS 3
676560OtherNDAMERICA'S PPO/ARAZ #
ND100038OtherMNLHS #
142308OtherNDUCARE #
15375MedicaidND
0106108OtherNDMEDICA #
93416DOOtherNDMNBS #
00A28DOOtherNDMNBS #
0106110OtherNDMEDICA #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071204000854 ND Practitioner - Family Practice 5698864270 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Dakota School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Innovis Health LLCGroup PAC ID 9931298155, 561 clinicians

Practice addresses (Care Compare)

1702 University Dr S
Fargo, ND 58103-4940
Phone (701) 364-8900

3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000

4622 40TH Ave S
Suite a
Fargo, ND 58104-4394
Phone (701) 364-8900

5 9TH Ave N
Casselton, ND 58012-3339
Phone (701) 347-4445

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions15
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
5341NDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Innovis Health LLC Family Medicine CurrentSince Jan 1, 2008 Accepting new patients
Innovis Health, LLC Current Accepting new patients
Innovis Health LLC Family Medicine CurrentSince Jan 1, 2008 Accepting new patients
Sisters of Mary of the Presentation Long Term Care Past Accepting new patients
Sisters of Mary of the Presentation Long-Term Care Past Accepting new patients

Locations

1702 University Dr S
Fargo, ND 58103
Phone (701) 364-4222

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000

Organizations & group practices 5

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 11

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": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318809600000",
    "number": "1730106329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6001",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581086001",
            "telephone_number": "701-364-3300",
            "fax_number": "701-364-8906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 9TH AVE N",
            "city": "CASSELTON",
            "state": "ND",
            "postal_code": "580123339",
            "telephone_number": "701-347-4445",
            "fax_number": "701-347-5276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMM",
        "first_name": "BRUCE",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2011-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "5341",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA #",
            "identifier": "0108127",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIOUX VALLEY #",
            "identifier": "37983",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112583400",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE #",
            "identifier": "DA9011015505",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS #",
            "identifier": "HP19507",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NDBS #",
            "identifier": "336",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MNBS 3",
            "identifier": "93416DO",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICA'S PPO/ARAZ #",
            "identifier": "676560",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LHS #",
            "identifier": "ND100038",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE #",
            "identifier": "142308",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15375",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA #",
            "identifier": "0106108",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MNBS #",
            "identifier": "93416DO",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MNBS #",
            "identifier": "00A28DO",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA #",
            "identifier": "0106110",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Casselton, ND

Sources for this page

Verify at the official NPI Registry.