Individual provider Active NPI

Valerie Jean Pendleton

  • Surgery Physician
  • Grand Forks, ND
National Provider Identifier
1912639253
Registry record updated Jun 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
RL18459 Issued in ND
Practice address
1301 N Columbia Rd Stop 9037
Grand Forks, ND 58202-9037
Phone
(701) 777-3069
NPI assigned
Jun 27, 2022
Last updated
Jun 27, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 27, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X RL18459 ND Primary

Addresses

Primary practice location

1301 N Columbia Rd Stop 9037
Grand Forks, ND 58202-9037

Mailing address

1301 N Columbia Rd Stop 9037
Grand Forks, ND 58202-9037
Phone (701) 777-3069

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220921001798 ND Order and Referring Only - General SurgeryPractitioner - General Surgery 0244615615

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1656288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656288000000",
    "number": "1912639253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 N COLUMBIA RD STOP 9037",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582029037",
            "telephone_number": "701-777-3069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 N COLUMBIA RD STOP 9037",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582029037",
            "telephone_number": "701-777-3069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDLETON",
        "first_name": "VALERIE",
        "middle_name": "JEAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-27",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ND",
            "license": "RL18459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.