Individual provider Active NPI

Elisha D Anderson, NP-C

  • Nurse Practitioner
  • Lisbon, ND
National Provider Identifier
1851698344
Registry record updated Apr 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R30898 Issued in ND
Practice address
819 Main St
Lisbon, ND 58054-4244
Phone
(701) 683-4134
Fax
(701) 683-4094
NPI assigned
Feb 17, 2011
Last updated
Apr 24, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X R30898 ND Primary

Addresses

Primary practice location

819 Main St
Lisbon, ND 58054-4244

Mailing address

PO Box 6001
Fargo, ND 58108-6001
Phone (701) 683-4134

Other identifiers 1

IdentifierTypeStateIssuer
84045MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110412001029 ND Practitioner - Nurse Practitioner 3476737644 Reassigns benefits to 1 organization
I20160721002071 MN Practitioner - Nurse Practitioner 3476737644 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Innovis Health LLCGroup PAC ID 9931298155, shared by 7 NPIs, 561 clinicians

Practice addresses (Care Compare)

208 Oppegard Ave NW
Twin Valley, MN 56584-4038
Phone (218) 584-5181

2400 St Francis Dr
Breckenridge, MN 56520-1025
Phone (218) 643-3000

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

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

501 Main Ave S
Hankinson, ND 58041-4108
Phone (701) 242-7118

819 Main St
Lisbon, ND 58054-4244
Phone (701) 683-4134

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Innovis Health, LLC. CurrentSince Feb 28, 2011 Accepting new patients
Innovis Health LLC CurrentSince Feb 28, 2011 Accepting new patients
Innovis Health, LLC Current Accepting new patients
Innovis Health LLC CurrentSince Jun 21, 2016 Accepting new patients

Locations

208 Oppegard Ave NW
Twin Valley, MN 56584
Phone (218) 584-5181

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

3000 32nd Ave 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1297900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335225600000",
    "number": "1851698344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6001",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581086001",
            "telephone_number": "701-683-4134",
            "fax_number": "701-683-4094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 MAIN ST",
            "city": "LISBON",
            "state": "ND",
            "postal_code": "580544244",
            "telephone_number": "701-683-4134",
            "fax_number": "701-683-4094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "ELISHA",
        "middle_name": "D",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-17",
        "last_updated": "2012-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ND",
            "license": "R30898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "84045",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lisbon, ND

Sources for this page

Verify at the official NPI Registry.