NPIMap

Organization Active NPI

Innovis Health, LLC

Doing business as Essentia Health 45th Street Clinic

  • Multi-Specialty Clinic/Center
  • Fargo, ND
National Provider Identifier
1891453411
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
INNOVIS HEALTH, LLC
Doing business as
Essentia Health 45th Street Clinic
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
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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Multi-Specialty Clinic/Center 261QM1300X Primary

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 1

  • Essentia Health 45th Street Clinic Doing business as

Medicare participation

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

Enrollment records 1

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…

Other NPIs on the same Medicare enrollment 20

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

View all 20

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
35D1001562Essentia Health - 45TH St Clinic4476 31St Ave S, Fargo, ND 58104Certificate of waiverAug 7, 2027

National Provider Directory

National Provider Directory

Locations

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

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1638316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1891453411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4476 31ST AVE S STE 101",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044532",
            "telephone_number": "701-234-9400",
            "fax_number": "701-234-9401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4476 31ST AVE S STE 101",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044532",
            "telephone_number": "701-234-9400",
            "fax_number": "701-234-9401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVIS HEALTH, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2021-12-01",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health 45th Street Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health 45th Street Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.