NPIMap

Individual provider Active NPI

Alex Lunneborg, PA-C

  • Physician Assistant
  • West Fargo, ND
National Provider Identifier
1962072645
Registry record updated Jun 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PAC0981 Issued in ND
Practice address
350 23Rd Ave E Ste 102
West Fargo, ND 58078-7402
Phone
(701) 707-0200
Fax
(701) 707-0210
NPI assigned
Jun 25, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X PAC0981 ND Primary

Addresses

Primary practice location

350 23Rd Ave E Ste 102
West Fargo, ND 58078-7402

Mailing address

350 23Rd Ave E Ste 102
West Fargo, ND 58078-7402
Phone (701) 707-0200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address alunneborg@direct.yanktonmedicalclinic.nextgenshare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, ND2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210830003368 SD Practitioner - Physician Assistant 9931505930 Reassigns benefits to 1 organization
I20221124000153 ND Practitioner - Physician Assistant 9931505930 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Matthew Friederichs MD PLLCGroup PAC ID 5395123558, 2 clinicians

Practice addresses (Care Compare)

350 23Rd Ave E
Suite 102
West Fargo, ND 58078-1800
Phone (701) 707-0200

Hospital & facility affiliations

  • Sanford Medical Center Fargo Hospital, Fargo, ND, CCN 350011
  • Essentia Health Hospital, Fargo, ND, CCN 350070

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lisbon Area Health Services CurrentSince Nov 1, 2022 Accepting new patients
Mercy Hospital CurrentSince Nov 1, 2022 Accepting new patients
Coteau Des Prairies Hospital CurrentSince Feb 1, 2023 Accepting new patients
Coteau Des Prairies Hospital CurrentSince Feb 1, 2023 Accepting new patients

Locations

3276 Solutions Ctr
Chicago, IL 60677

570 Chautauqua Blvd
Valley City, ND 58072
Phone (701) 845-0440

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1624579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1962072645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 23RD AVE E STE 102",
            "city": "WEST FARGO",
            "state": "ND",
            "postal_code": "580787402",
            "telephone_number": "701-707-0200",
            "fax_number": "701-707-0210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 23RD AVE E STE 102",
            "city": "WEST FARGO",
            "state": "ND",
            "postal_code": "580787402",
            "telephone_number": "701-707-0200",
            "fax_number": "701-707-0210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUNNEBORG",
        "first_name": "ALEX",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-25",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "alunneborg@direct.yanktonmedicalclinic.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "101 S Plum St",
            "city": "Vermillion",
            "state": "SD",
            "country_code": "US",
            "postal_code": "570693306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in West Fargo, ND

Sources for this page

Verify at the official NPI Registry.