NPIMap

Organization Active NPI

Innovis Health, LLC.

Doing business as Essentia Health Wahpeton Clinic

  • Family Medicine Physician
  • Wahpeton, ND
National Provider Identifier
1790965440
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
INNOVIS HEALTH, LLC.
Doing business as
Essentia Health Wahpeton Clinic
Practice address
275 11TH St S
Wahpeton, ND 58075-4655
Phone
(701) 642-2000
Fax
(701) 671-4153
NPI assigned
Nov 10, 2007
Last updated
Mar 1, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Authorized official

Name
Alan Hurley
Title
Coo
Phone
(701) 364-7667

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

275 11TH St S
Wahpeton, ND 58075-4655

Mailing address

275 11TH St S
Wahpeton, ND 58075-4655
Phone (701) 642-2000

Other identifiers 1

IdentifierTypeStateIssuer
046927000MedicaidMN

Other names 1

  • Essentia Health Wahpeton Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20071211000158 ND Part B Supplier - Clinic/Group Practice 9931298155 Receives reassigned benefits from 693 practitioners
22 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jamestown, ND; West Fargo, ND; Wahpeton, ND; Valley City, ND; Lisbon, ND; Hankinson, ND; Fargo, ND; Bismarck, ND…
O20080115000831 MN Part B Supplier - Clinic/Group Practice 9931298155 Receives reassigned benefits from 108 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fergus Falls, MN; Wheaton, MN; Ulen, MN; Twin Valley, MN; Thief River Falls, MN; Park Rapids, MN; Moorhead, MN; Duluth, MN…
O20100930091825 ND DME Supplier - Physician - OptometristDME Supplier - Optician 9931298155 Practice locations: Wahpeton, ND

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 25

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 25

National Provider Directory

National Provider Directory

Locations

3902 13th Ave S
Ste 3704
Fargo, ND 58103
Phone (701) 364-6600

Ownership & related parties

All facility ownership & control disclosures 24

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Essentia Health St Mary's Detroit LakesDetroit Lakes, MN, CCN 240101 Hospital Operational/Managerial Control Jan 1, 2017
Essentia Health FosstonFosston, MN, CCN 241357 Hospital Operational/Managerial Control Jan 1, 2017
Essentia Health AdaAda, MN, CCN 241313 Hospital Operational/Managerial Control Jan 1, 2017
Essentia Health FosstonFosston, MN, CCN 24Z357 Hospital Operational/Managerial Control Jan 1, 2017
Essentia Health Holy Trinity HospitalGraceville, MN, CCN 241321 Hospital Operational/Managerial Control Jan 1, 2017
Essentia Health Holy Trinity HospitalGraceville, MN, CCN 24Z321 Hospital Operational/Managerial Control Jan 1, 2017
Essentia Health AdaAda, MN, CCN 24Z313 Hospital Operational/Managerial Control Jan 1, 2017
Essentia Health - Oak CrossingDetroit Lakes, MN, CCN 245212 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2017
Jan 29, 2025
Essentia Health Grace HomeGraceville, MN, CCN 245579B Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2017
Jan 29, 2025
Essentia Health First Care Living CenterFosston, MN, CCN 245512 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2017
Jan 29, 2025
Essentia Health Home Care WestDetroit Lakes, MN, CCN 248052 Home health agency Operational/Managerial Control Jan 1, 2011
Essentia Health Home Care GracevilleGraceville, MN, CCN 248045 Home health agency Operational/Managerial Control Jan 1, 2011
Essentia Health Hospice WestFosston, MN, CCN 241564 Hospice Operational/Managerial Control (100%) Jan 1, 2011
Essentia Health Ada ClinicAda, MN, CCN 243416 Rural health clinic Operational/Managerial Control Jan 1, 2017
Essentia Health Graceville ClinicGraceville, MN, CCN 243997B Rural health clinic Operational/Managerial Control Jan 1, 2017
Essentia Health Oklee ClinicOklee, MN, CCN 243464 Rural health clinic Operational/Managerial Control Jan 1, 2017
Essentia Health Bagley ClinicBagley, MN, CCN 243461 Rural health clinic Operational/Managerial Control Jan 1, 2017
Essentia Health St Mary's Mahnomen ClinicMahnomen, MN, CCN 243468 Rural health clinic Operational/Managerial Control Jan 1, 2017
Essentia Health St Mary's Pelican Rapids ClinicPelican Rapids, MN, CCN 243472 Rural health clinic Operational/Managerial Control Jan 1, 2017
Essentia Health Park Rapids ClinicPark Rapids, MN, CCN 243471 Rural health clinic Operational/Managerial Control Jan 1, 2017
Essentia Health Menahga ClinicMenahga, MN, CCN 243475 Rural health clinic Operational/Managerial Control Jan 1, 2017
Essentia Health Walker ClinicWalker, MN, CCN 243474 Rural health clinic Operational/Managerial Control Jan 1, 2017
Essentia Health St. Mary's Frazee ClinicFrazee, MN, CCN 243492 Rural health clinic Operational/Managerial Control Apr 1, 2019
Essentia Health Park Rapids Hwy 34 ClinicPark Rapids, MN, CCN 243493 Rural health clinic Operational/Managerial Control Aug 17, 2020

Owned or controlled facilities with NPI records 24

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 24

Practitioners & affiliated clinicians

Practitioners 46

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1194652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1790965440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 11TH ST S",
            "city": "WAHPETON",
            "state": "ND",
            "postal_code": "580754655",
            "telephone_number": "701-642-2000",
            "fax_number": "701-671-4153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 11TH ST S",
            "city": "WAHPETON",
            "state": "ND",
            "postal_code": "580754655",
            "telephone_number": "701-642-2000",
            "fax_number": "701-671-4153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVIS HEALTH, LLC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2007-11-10",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "HURLEY",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "701-364-7667"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046927000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Wahpeton Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Wahpeton Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wahpeton, ND

Sources for this page

Verify at the official NPI Registry.