Pam Physician Enterprise
Organization Active NPI Physical Medicine & Rehabilitation Physician · Fargo, ND
NPI 1962856161 · NPPES record last updated Aug 31, 2022
Key facts
- NPI
- 1962856161
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- Legal business name
- PAM PHYSICIAN ENTERPRISE
- Practice address
- 4671 38TH St S
Fargo, ND 58104-7866 - Phone
- (701) 540-9544
- NPI assigned
- Apr 14, 2016
- Organization subpart
- No
Authorized official
- Name
- Adam Burick
- Title
- Cmo/Authorized Director
- Phone
- (717) 317-9313
Other NPIs on the same Medicare enrollment 1
Practitioners 79
-
Jantey Y Carey, MD
-
Scott J Fillmore, MD
-
Aaron Roy Robertson, M.D.
-
Kirill Alekseyev, MD, MBA
-
Jeffrey Walter Anderson, D.O.
-
Jenee Lee Bowman, MD
-
Toai Phuoc Bui, DO
-
Mariam Chowdhry, D.O.
-
Dolores Contreras Urby, M.D.
-
Gabrielle Faye Daniel, M.D.
-
Acadia Matilda Joines, RN, FNP-C
-
Luke Meng, M.D.
-
Patrick W Mulroy, MD
-
Cory Osborne, DO
-
Samuel Park III, M.D.
-
Jo Anna Ramos, NP-C
-
Rachel Kaye Shafer, MSN, APRN, AGNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (11 enrollments) in TX, DE, MO, LA, ND, NC, FL, MA, WI, CO, KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160929001462 | TX | Part B Supplier - Clinic/Group Practice | 1254628589 |
Receives reassigned benefits from 36 practitioners Practice locations: San Antonio, TX; Richardson, TX; Texarkana, TX; Victoria, TX; Webster, TX; Round Rock, TX; New Braunfels, TX; Luling, TX… |
| O20190221002661 | DE | Part B Supplier - Clinic/Group Practice | 1254628589 |
Receives reassigned benefits from 6 practitioners Practice locations: Dover, DE; Georgetown, DE; Milford, DE |
| O20201023000325 | MO | Part B Supplier - Clinic/Group Practice | 1254628589 |
Receives reassigned benefits from 2 practitioners Practice locations: Chesterfield, MO |
| O20210310002188 | LA | Part B Supplier - Clinic/Group Practice | 1254628589 |
Receives reassigned benefits from 1 practitioner Practice locations: Covington, LA |
| O20210413000857 | ND | Part B Supplier - Clinic/Group Practice | 1254628589 |
Receives reassigned benefits from 11 practitioners Practice locations: Fargo, ND |
| O20211026000974 | NC | Part B Supplier - Clinic/Group Practice | 1254628589 |
Receives reassigned benefits from 2 practitioners Practice locations: Rocky Mount, NC |
| O20220709000282 | FL | Part B Supplier - Clinic/Group Practice | 1254628589 |
Receives reassigned benefits from 6 practitioners 1 other NPI on this enrollment Practice locations: Tavares, FL; Sarasota, FL; Nokomis, FL; Jupiter, FL; Jacksonville, FL |
| O20230209001192 | MA | Part B Supplier - Clinic/Group Practice | 1254628589 |
Receives reassigned benefits from 6 practitioners Practice locations: Stoughton, MA |
| O20240617000334 | WI | Part B Supplier - Clinic/Group Practice | 1254628589 |
Receives reassigned benefits from 2 practitioners Practice locations: Wausau, WI |
| O20241028003773 | CO | Part B Supplier - Clinic/Group Practice | 1254628589 |
Receives reassigned benefits from 1 practitioner Practice locations: Brighton, CO; Westminster, CO; Lafayette, CO; Golden, CO; Denver, CO |
| O20251028003898 | KS | Part B Supplier - Clinic/Group Practice | 1254628589 |
Receives reassigned benefits from 1 practitioner Practice locations: Overland Park, KS |
National Provider Directory
Locations
100 Wellness Way
Milford, DE 19963
Phone (302) 422-3311
575 N River St
Fl 7
Wilkes Barre, PA 18764
Phone (570) 208-3310
575 N River St
#7
Wilkes Barre, PA 18764
1001 Raintree Cir
Allen, TX 75013
Phone (972) 898-9557
1445 Hanz Dr
Spc Hosp
New Braunfels, TX 78130
Phone (830) 627-7600
17448 Highway 3
Ste 140
Webster, TX 77598
Phone (281) 332-1755
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician |
208100000X | Yes |
Addresses
Primary practice location
4671 38TH St S
Fargo, ND 58104-7866
Mailing address
PO Box 206478
Dallas, TX 75320-1233
Other practice location 1
1828 Good Hope Rd
102
Enola, PA 17025-1233
Phone (717) 731-9665
Other practice location 2
6150 Edgelake Dr
Sarasota, FL 34240-8803
Phone (941) 342-3201
Other practice location 3
5101 Medical Dr
San Antonio, TX 78229-4801
Phone (210) 616-0100
Other providers in Fargo, ND
- Nichole Sherry Palmer-George
- Ashley Anne Palmer
- Erika Palmer
- Nicole S Palmer
- Pam Cubed Rehabilitation Hospital of Fargo LLC
- Colette Pameijer
- Caitlin L. Pandolfo
- Sarah Francine Pangelinan
- Chelsa Lyn Pansch
- Lydia Pansegrau
All providers in Fargo, ND · Physical Medicine & Rehabilitation Physician 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 31, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.