Active NPI
Mark Poolman
- Health Educator
- Grand Forks, ND
National Provider Identifier
1750790358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Educator
- License
- 143-95
- Practice address
- 1 Ralph Engelstad Arena Dr
Grand Forks, ND 58203-2205 - Phone
- (701) 777-3107
- Fax
- (701) 777-6974
- NPI assigned
- Aug 7, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Educator | 174H00000X | 143-95 | ND | Primary |
Addresses
Primary practice location
1 Ralph Engelstad Arena Dr
Grand Forks, ND 58203-2205
Mailing address
2324 Pebble Beach Rd
East Grand Forks, MN 56721-9002
Phone (218) 773-2142
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 143-95 | ND | MD | Health Educator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407369600000",
"number": "1750790358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2324 PEBBLE BEACH RD",
"city": "EAST GRAND FORKS",
"state": "MN",
"postal_code": "567219002",
"telephone_number": "218-773-2142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 RALPH ENGELSTAD ARENA DR",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582032205",
"telephone_number": "701-777-3107",
"fax_number": "701-777-6974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POOLMAN",
"first_name": "MARK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-08-07",
"last_updated": "2014-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": "ND",
"license": "143-95",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Forks, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.