Innovis Health, LLC
Organization Active NPI Multi-Specialty Clinic/Center · Fargo, ND
NPI 1891453411 · NPPES record last updated Mar 1, 2024
Key facts
- NPI
- 1891453411
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- INNOVIS HEALTH, LLC
- Practice address
- 4476 31St Ave S Ste 101
Fargo, ND 58104-4532 - Phone
- (701) 234-9400
- Fax
- (701) 234-9401
- NPI assigned
- Dec 1, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- ESSENTIA HEALTH
Authorized official
- Name
- Alan Hurley
- Title
- Coo
- Phone
- (701) 364-7667
Other NPIs on the same Medicare enrollment 20
Practitioners 18
-
Ariel Elizabeth Bibb, CRNA
-
Alicia Lynn Blaufuss, APRN, CNP
-
Cherie Lynn Dowell, MPAS
-
Daniel Hoy, MD
-
Ravindra P Joshi, M.D.
-
John Seifert, MPAS, MPH
-
Samantha Lynn Simley, PA-C
-
Michelle L Carl, APRN,CNP
-
Chong Hyun Choe, M.D.
-
Christine B Hills, M.D.
-
Cindy L Otto, APRN,CNP
-
Riana Christine Rhoden, M.D.
-
Rylee Ann Zetocha, APRN, FNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 35D1001562 | Essentia Health - 45TH St Clinic | Certificate of waiver | Aug 7, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
4476 31St Ave S Ste 101
Fargo, ND 58104-4532
Mailing address
4476 31St Ave S Ste 101
Fargo, ND 58104-4532
Phone (701) 234-9400
Other names
- Essentia Health 45th Street Clinic
Other providers in Fargo, ND
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All providers in Fargo, ND · Multi-Specialty Clinic/Center in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.