NPIMap

Individual provider Active NPI

Codi Guck, DO

  • Pain Medicine Physician
  • Fargo, ND
National Provider Identifier
1790205771
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
18109 Issued in ND
Practice address
3000 32ND Ave S Ste 101
Fargo, ND 58103-6132
Phone
(017) 364-8000
Fax
(701) 551-6984
NPI assigned
Jun 21, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 18109 ND
Pain Medicine (Anesthesiology) Physician 207LP2900X 18109 ND
Pain Medicine Physician 208VP0000X 18109 ND Primary

Addresses

Primary practice location

3000 32ND Ave S Ste 101
Fargo, ND 58103-6132

Mailing address

1702 University Dr S
Fargo, ND 58103-4940
Phone (017) 364-8000

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
I20220524002936 ND Practitioner - Interventional Pain ManagementPractitioner - Anesthesiology 7113291675 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional Pain ManagementAlso: Anesthesiology
Education
Other, 2017
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)

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

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7988NEMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Innovis Health, LLC CurrentSince Mar 11, 2024 Accepting new patients
Innovis Health, LLC Current Accepting new patients
Innovis Health LLC CurrentSince Mar 11, 2024 Accepting new patients
Center for Pain Medicine, P.a. CurrentSince Jul 1, 2022 Accepting new patients

Locations

2401 41st St S
Ste 101
Fargo, ND 58104
Phone (701) 388-3947

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

3000 32nd Ave S
Ste 101
Fargo, ND 58103

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

Organizations & group practices 4

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.

Hospital & facility affiliations 10

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": "1498003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1790205771",
    "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",
            "telephone_number": "017-364-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 32ND AVE S STE 101",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036132",
            "telephone_number": "017-364-8000",
            "fax_number": "701-551-6984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUCK",
        "first_name": "CODI",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-21",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "ND",
            "license": "18109",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "ND",
            "license": "18109",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "ND",
            "license": "18109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.