NPIMap

Individual provider Active NPI

Toni Rheault

  • Physician Assistant
  • Fargo, ND
National Provider Identifier
1881093029
Registry record updated Dec 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PAC0573 Issued in ND
Practice address
3000 32ND Ave S
Fargo, ND 58103-6132
Phone
(701) 364-8000
Fax
(701) 364-8078
NPI assigned
Aug 13, 2014
Last updated
Dec 28, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PAC0573 ND Primary
Physician Assistant 363A00000X R962 ND

Addresses

Primary practice location

3000 32ND Ave S
Fargo, ND 58103-6132

Mailing address

PO Box 6001
Fargo, ND 58108-6001
Phone (701) 364-8000

Other names 1

  • Toni Nelson Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20141217000008 ND Practitioner - Physician Assistant 2062735434 Reassigns benefits to 1 organization
I20150911000896 MN Practitioner - Physician Assistant 2062735434 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Marys Regional Health CenterGroup PAC ID 2062326820, 190 clinicians
Innovis Health LLCGroup PAC ID 9931298155, 561 clinicians

Practice addresses (Care Compare)

1027 Washington Ave
Detroit Lakes, MN 56501-3409
Phone (218) 844-2300

1702 University Dr S
Fargo, ND 58103-4940
Phone (701) 364-8900

2430 20TH St SW
Jamestown, ND 58401-6201
Phone (701) 253-5300

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

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

705 Pleasant Ave S
Park Rapids, MN 56470-1440
Phone (218) 732-2800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PAC0573NDMDPhysician Assistant
R962NDMDPhysician Assistant
11723MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Innovis Health LLC CurrentSince Nov 3, 2014 Accepting new patients
St. Mary's Regional Health Center CurrentSince Aug 21, 2015 Accepting new patients
Innovis Health, LLC CurrentSince Nov 3, 2014 Accepting new patients
St Mary's Regional Health Center CurrentSince Aug 21, 2015 Accepting new patients
Innovis Health, LLC Past Accepting new patients
St Marys Regional Health Center Past Accepting new patients

Locations

1027 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 844-2300

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

900 Hilligoss Blvd SE
Fosston, MN 56542
Phone (218) 435-1133

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

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

2430 20th St SW
Jamestown, ND 58401
Phone (701) 253-5300

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

Organizations & group practices 7

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 7

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": "1407888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451260800000",
    "number": "1881093029",
    "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": "701-364-8000",
            "fax_number": "701-364-8078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 32ND AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036132",
            "telephone_number": "701-364-8000",
            "fax_number": "701-364-8078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RHEAULT",
        "first_name": "TONI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-13",
        "last_updated": "2015-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0573",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "R962",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TONI",
            "last_name": "NELSON",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.