NPIMap

Organization Active NPI

North Dakota Eye Clinic, LTD

  • Specialist
  • Grand Forks, ND
National Provider Identifier
1972563815
Registry record updated May 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
8411 Issued in ND
Legal business name
NORTH DAKOTA EYE CLINIC, LTD
Practice address
1820 S 42ND St.
Grand Forks, ND 58201-5820
Phone
(017) 775-3151
Fax
(701) 775-3153
NPI assigned
Mar 24, 2006
Last updated
May 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2023

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

Authorized official

Name
Dr. Mark L. Sczepanski, MDNPI 1295731040
Title
Vice President
Phone
(701) 775-3151

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 8411 ND Primary
Medical Specialty Clinic/Center 261QM2500X 8411 ND

Addresses

Primary practice location

1820 S 42ND St.
Grand Forks, ND 58201-5820

Mailing address

1820 S 42ND St.
Grand Forks, ND 58201-4018
Phone (701) 775-3151

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040330001687 ND Part B Supplier - Clinic/Group Practice 0648262808 Receives reassigned benefits from 5 practitioners
Practice locations: Grand Forks, ND
O20050923000200 MN Part B Supplier - Clinic/Group Practice 0648262808 Receives reassigned benefits from 2 practitioners
Practice locations: Thief River Falls, MN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
North Dakota Eye Clinic LTD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2017 Highway 59 S
Thief River Falls, MN 56701
Phone (218) 681-1777

Interoperability endpoints

  • Direct secure messaging: jnelson@ndec.intellechartdirect.net
  • Direct secure messaging: kaikens@ndec.intellechartdirect.net
  • Direct secure messaging: msczepanski@ndec.intellechartdirect.net
  • Direct secure messaging: tboettcher@ndec.intellechartdirect.net
  • Direct secure messaging: tdunham@ndec.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683763200000",
    "number": "1972563815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 S 42ND ST.",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014018",
            "telephone_number": "701-775-3151",
            "fax_number": "701-775-3153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 S 42ND ST.",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582015820",
            "telephone_number": "017-775-3151",
            "fax_number": "701-775-3153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH DAKOTA EYE CLINIC, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-24",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A",
        "authorized_official_last_name": "SCZEPANSKI",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "701-775-3151",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "ND",
            "license": "8411",
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "ND",
            "license": "8411",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; 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.