NPIMap

Organization Active NPI

Suedel Therapeutics PLLC

  • Physical Medicine & Rehabilitation Physician
  • Grand Forks, ND
National Provider Identifier
1902446271
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
SUEDEL THERAPEUTICS PLLC
Practice address
3535 S 31St St Ste 105
Grand Forks, ND 58201-3592
Phone
(701) 317-2897
Fax
(701) 213-4345
NPI assigned
Jan 14, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2022

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

Authorized official

Name
Stephanie Suedel, OTNPI 1053505214
Title
Authorized Official
Phone
(701) 317-2897

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary
Occupational TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

3535 S 31St St Ste 105
Grand Forks, ND 58201-3592

Mailing address

1311 S Washington St
Grand Forks, ND 58201-5406
Phone (701) 317-2897

Other practice location 1

1311 S Washington St
Grand Forks, ND 58201-5406
Phone (701) 317-2897

Other practice location 2

117 N Washington St
Grand Forks, ND 58203-3450
Phone (701) 317-2897

Other identifiers 1

IdentifierTypeStateIssuer
SUE78-1717OtherNDDRIVERS LICENSE

Other names 1

  • Suedel Therapeutics & Wellness Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL GrandForks

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200406000022 ND Part B Supplier - Clinic/Group Practice 7810326337 Receives reassigned benefits from 10 practitioners
Practice locations: Grand Forks, ND

National Provider Directory

National Provider Directory

Locations

117 N Washington St
Ste D
Grand Forks, ND 58203
Phone (701) 317-2897

3535 S 31st St
Ste 105
Grand Forks, ND 58201
Phone (701) 317-2897

1311 S Washington St
Grand Forks, ND 58201
Phone (701) 317-2897

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666051200000",
    "number": "1902446271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 S WASHINGTON ST",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582015406",
            "telephone_number": "701-317-2897",
            "fax_number": "701-213-4345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 S 31ST ST STE 105",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582013592",
            "telephone_number": "701-317-2897",
            "fax_number": "701-213-4345"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1311 S Washington St",
            "address_purpose": "LOCATION",
            "city": "Grand Forks",
            "state": "ND",
            "postal_code": "582015406",
            "country_code": "US",
            "telephone_number": "701-317-2897",
            "fax_number": "701-213-4345",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "117 N Washington St",
            "address_purpose": "LOCATION",
            "city": "Grand Forks",
            "state": "ND",
            "postal_code": "582033450",
            "country_code": "US",
            "telephone_number": "701-317-2897",
            "fax_number": "701-213-4345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SUEDEL THERAPEUTICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-14",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A",
        "authorized_official_last_name": "SUEDEL",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "701-317-2897",
        "authorized_official_credential": "OT"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVERS LICENSE",
            "identifier": "SUE78-1717",
            "state": "ND"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "GrandForks",
            "affiliation": "N",
            "address_1": "1311 S Washington St",
            "city": "Grand Forks",
            "state": "ND",
            "country_code": "US",
            "postal_code": "582015406",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Suedel Therapeutics & Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Suedel Therapeutics & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Forks, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; 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.