NPIMap

Organization Active NPI

Fairlight Medical Center

  • Urgent Care Clinic/Center
  • Williston, ND
National Provider Identifier
1811162811
Registry record updated Mar 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
6414 Issued in ND
Legal business name
FAIRLIGHT MEDICAL CENTER
Practice address
3 4TH St E
Williston, ND 58801-5350
Phone
(701) 577-6337
Fax
(701) 577-4867
NPI assigned
Apr 30, 2008
Last updated
Mar 13, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
WILLISTON RADIOLOGY CONSULTANTS PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 13, 2020

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

Authorized official

Name
Dr. Leszek J Jaszczak, MDNPI 1467528455
Title
President/Owner
Phone
(701) 577-6337

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X 6414 ND Primary

Addresses

Primary practice location

3 4TH St E
Williston, ND 58801-5350

Mailing address

3 East 4TH Street
PO Box 1148
Williston, ND 58802-1148
Phone (701) 577-6337

Other identifiers 5

IdentifierTypeStateIssuer
109956169OtherNDDUNS
269-961-7243OtherNDTPIN
621-111OtherNDNAICS
010182MedicaidND
0406731MedicaidMT

Other names 1

  • Williston Radiology Consultants Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041005001169 ND Part B Supplier - Clinic/Group Practice 2365334828 Receives reassigned benefits from 7 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Williston, ND

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Williston Radiology Cons PC

Locations

3 4th St E
Apt 101
Williston, ND 58801
Phone (701) 577-6337

3 4th St E
Apt 201
Williston, ND 58801
Phone (701) 577-4867

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584057600000",
    "number": "1811162811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 EAST 4TH STREET",
            "address_2": "PO BOX 1148",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588021148",
            "telephone_number": "701-577-6337",
            "fax_number": "701-577-4867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 4TH ST E",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588015350",
            "telephone_number": "701-577-6337",
            "fax_number": "701-577-4867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRLIGHT MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLISTON RADIOLOGY CONSULTANTS PC",
        "enumeration_date": "2008-04-30",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A",
        "authorized_official_last_name": "JASZCZAK",
        "authorized_official_first_name": "LESZEK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "701-577-6337",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "ND",
            "license": "6414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DUNS",
            "identifier": "109956169",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TPIN",
            "identifier": "269-961-7243",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NAICS",
            "identifier": "621-111",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010182",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0406731",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Williston Radiology Consultants",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Williston Radiology Consultants",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Williston, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.