Foundations Mental Health Clinic, PC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

FOUNDATIONS MENTAL HEALTH CLINIC, PC

Practice address

4040 42ND St S Ste N
Fargo, ND 58104-4352

Phone

(701) 388-5825

NPI assigned

Nov 6, 2024

Organization subpart

No

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

Authorized official

Name

Jordan Wiedmann, PA-CNPI 1750908455

Title

Owner

Phone

(701) 543-5533

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Locations

Practitioners 3

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.

• Jordan Ann Wiedmann, PA-C

  • Physician Assistant
  • Fargo, ND
  • NPI 1750908455
  Medicare reassignment Care Compare group Authorized official
• Lindsey Mae Hiatt, PA

  • Physician Assistant
  • Fargo, ND
  • NPI 1407412505
  Medicare reassignment Care Compare group
• Danielle Swanson, PA-C

  • Physician Assistant
  • Fargo, ND
  • NPI 1801455449
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1730851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733356800000",
    "number": "1932922085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4040 42ND ST S STE N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4040 42ND ST S STE N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044352",
            "telephone_number": "701-388-5825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNDATIONS MENTAL HEALTH CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-06",
        "last_updated": "2024-12-05",
        "certification_date": "2024-11-23",
        "status": "A",
        "authorized_official_last_name": "WIEDMANN",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-543-5533",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Erica Foss, COTA/L
• Tricia M Fossum, NP
• Bryce Nicole Foster
• Constance Foster
• Ethan Foster, M.D.
• Foundations Natural Medicine PLLC Dba Lagom Wellness Clinic
• Stephanie Fountain, MD
• Four Elements Therapy PLLC
• Aaron Allen Fowler
• James D Fowler, MD

• Psychiatry Physician in Fargo, ND
• Providers in Fargo, ND by specialty
• Psychiatry Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2024; 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.