Vicki L Andvik, PA-C
Individual provider Active NPI Physician Assistant · Fargo, ND
NPI 1962676635 · NPPES record last updated Aug 14, 2017
Key facts
- NPI
- 1962676635
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PAC0693 (ND)
- Practice address
- 3000 32ND Ave S
Fargo, ND 58103-6132 - Phone
- (701) 364-8000
- Fax
- (701) 364-8078
- NPI assigned
- Apr 14, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 9
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Innovis Health LLC
Practice addresses (Care Compare)
3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000
Hospital & facility affiliations
- Essentia Health
- Essentia Health St Marys - Detroit Lakes
- Sanford Medical Center Fargo
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170831001567 | ND | Practitioner - Physician Assistant | 8123197902 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PAC0693 | ND | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innovis Health, LLC | Current |
Accepting new patients | |
| Innovis Health, LLC | Past | Accepting new patients |
Locations
400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364
3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PAC0693 | ND | Yes |
Addresses
Primary practice location
3000 32ND Ave S
Fargo, ND 58103-6132
Mailing address
PO Box 6001
Fargo, ND 58108-6001
Phone (701) 364-3300
Other providers in Fargo, ND
- Mercy Oforiwaa Andoh
- Andrew Wagner Chiropractic LLC
- Massa Julia Andrews
- Jordan Cole Andrud
- Debra Andvik
- Anesthesia Resources
- Angela Darveaux, OD, PC
- Robert Anthony Angotti
- Ani Mangold Psychological Services PLLC
- Samuel Odame Anim
All providers in Fargo, ND · Physician Assistant in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.