NPIMap

Individual provider Active NPI

Lisa Jo Jamsa Tollefson, MD

  • Family Medicine Physician
  • East Grand Forks, MN
National Provider Identifier
1962627398
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
51723 Issued in MN
Practice address
929 Central Ave NW
East Grand Forks, MN 56721
Phone
(218) 773-6800
NPI assigned
Apr 13, 2007
Last updated
Mar 7, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 10765 ND
Family Medicine Physician 207Q00000X RL10246 ND
Family Medicine Physician 207Q00000X 51723 MN Primary

Addresses

Primary practice location

929 Central Ave NW
East Grand Forks, MN 56721

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-9419

Other identifiers 1

IdentifierTypeStateIssuer
10562MedicaidND

Other names 1

  • Lisa Jamsa Tollefson Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 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
I20080602000223 ND Practitioner - Family Practice 4789754870 Reassigns benefits to 1 organization
I20100524000554 MN Practitioner - Family Practice 4789754870 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Dakota School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

1200 S Columbia Rd
Grand Forks, ND 58201-4036
Phone (701) 780-4348

1220 Sheyenne St
West Fargo, ND 58078-2637
Phone (701) 234-4445

1412 Main St
Hawley, MN 56549
Phone (218) 483-3564

2400 32ND Ave S
Fargo, ND 58103-5800
Phone (701) 234-2000

618 14TH Ave NE
Devils Lake, ND 58301-2808
Phone (701) 544-7000

621 Demers Ave
East Grand Forks, MN 56721-1812
Phone (218) 773-5857

929 Central Ave NW
East Grand Forks, MN 56721-1917
Phone (218) 773-6800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.99 of 100Reported as group
Quality
92.39
Promoting interoperability
100
Improvement activities
40
Cost
70.9

Merit-based Incentive Payment System (MIPS)

Final score
82.73 of 100Reported as group
Quality
71.75
Promoting interoperability
100
Improvement activities
40
Cost
70.68

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
51723MNMDFamily Medicine Physician
10765NDMDFamily Medicine Physician
RL10246NDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo Family Medicine CurrentSince Jul 1, 2022 Accepting new patients
Sanford Medical Center Fargo CurrentSince Jul 1, 2022 Accepting new patients
Altru Health System Past Accepting new patients
The Evangelical Lutheran Good Samaritan Society Past Accepting new patients
Lake Region Lutheran Home, Inc. Past Accepting new patients

Locations

929 Central Ave NW
East Grand Forks, MN 56721
Phone (218) 773-5932

4000 28th Ave S
Moorhead, MN 56560
Phone (701) 234-3200

2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800

801 Broadway N
Fargo, ND 58102
Phone (701) 234-5121

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

Organizations & group practices 5

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

Hospital & facility affiliations 11

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": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1962627398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-9419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 CENTRAL AVE NW",
            "city": "EAST GRAND FORKS",
            "state": "MN",
            "postal_code": "56721",
            "telephone_number": "218-773-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAMSA TOLLEFSON",
        "first_name": "LISA",
        "middle_name": "JO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-13",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "10765",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "RL10246",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "51723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10562",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "JAMSA TOLLEFSON",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in East Grand Forks, MN

Sources for this page

Verify at the official NPI Registry.