Individual provider Active NPI

Mari Charise Knudsen, MD

  • Pediatrics Physician
  • Fargo, ND
National Provider Identifier
1790282887
Registry record updated Jun 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
18887 Issued in ND
Practice address
1702 University Dr S
Fargo, ND 58103-4940
Phone
(701) 364-3300
NPI assigned
Apr 6, 2018
Last updated
Jun 10, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 99214 MT
Pediatrics Physician 208000000X 11405426-1205 UT
Pediatrics Physician 208000000X 18887 ND Primary

Addresses

Primary practice location

1702 University Dr S
Fargo, ND 58103-4940

Mailing address

1702 University Dr S
Fargo, ND 58103-4940

Other practice location 1

1273 Burns Way
Kalispell, MT 59901-3109
Phone (406) 752-8300

Other practice location 2

202 Conway Dr Ste 200
Kalispell, MT 59901-3153
Phone (406) 758-7490

Other names 1

  • Mari Goldade Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address krmcmedicalrecords@krhdirect.org Direct Kalispell Regional Medical Center Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MT2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221117002321 ND Practitioner - Pediatric Medicine 5799118659 Reassigns benefits to 1 organization
I20250625001073 MT Practitioner - Pediatric Medicine 5799118659 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18887NDMDPediatrics Physician
11405426-1205UTMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kalispell Regional Medical Center, Inc CurrentSince Aug 11, 2025 Accepting new patients
Innovis Health LLC CurrentSince Nov 7, 2022 Accepting new patients
Innovis Health, LLC Current Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Innovis Health, LLC CurrentSince Nov 7, 2022 Accepting new patients
Kalispell Regional Medical Center, Inc CurrentSince Aug 11, 2025 Accepting new patients
Kalispell Regional Medical Center, Inc Past Accepting new patients

Locations

1273 Burns Way
Kalispell, MT 59901
Phone (406) 752-5000

202 Conway Dr
Ste 100
Kalispell, MT 59901
Phone (406) 751-5666

202 Conway Dr
Ste 200
Kalispell, MT 59901
Phone (406) 752-8433

310 Sunnyview Ln
Kalispell, MT 59901
Phone (406) 751-5310

350 Heritage Way
Ste 2100
Kalispell, MT 59901
Phone (406) 257-8992

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

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-4222

Interoperability endpoints

  • Direct secure messaging: krmcmedicalrecords@krhdirect.org

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1522972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749513600000",
    "number": "1790282887",
    "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": "1702 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940",
            "telephone_number": "701-364-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1273 Burns Way",
            "address_purpose": "LOCATION",
            "city": "Kalispell",
            "state": "MT",
            "postal_code": "599013109",
            "country_code": "US",
            "telephone_number": "406-752-8300",
            "fax_number": "406-752-3542",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "202 Conway Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Kalispell",
            "state": "MT",
            "postal_code": "599013153",
            "country_code": "US",
            "telephone_number": "406-758-7490",
            "fax_number": "406-758-7080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KNUDSEN",
        "first_name": "MARI",
        "middle_name": "CHARISE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-06",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MT",
            "license": "99214",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "11405426-1205",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ND",
            "license": "18887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center Inc",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1273 Burns Way",
            "city": "Kalispell",
            "state": "MT",
            "country_code": "US",
            "postal_code": "599013109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARI",
            "last_name": "GOLDADE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.