Individual provider Active NPI

Puvanalingam Ayyadurai, MD

  • Cardiovascular Disease Physician
  • Grand Forks, ND
National Provider Identifier
1972919942
Registry record updated Jun 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
15887 Issued in ND
Practice address
1300 S Columbia Rd
Grand Forks, ND 58201-4012
Phone
(701) 780-2300
NPI assigned
Jul 10, 2014
Last updated
Jun 2, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Cardiovascular Disease Physician 207RC0000X 15887 ND Primary

Addresses

Primary practice location

1300 S Columbia Rd
Grand Forks, ND 58201-4012

Mailing address

2401 Demers Ave
Grand Forks, ND 58201
Phone (701) 780-4085

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200915000854 ND Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 9830511062 Reassigns benefits to 1 organization
I20201008000390 MN Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 9830511062 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Altru Health SystemGroup PAC ID 1355251604, shared by 14 NPIs, 675 clinicians

Practice addresses (Care Compare)

1300 S Columbia Rd
Grand Forks, ND 58201-4012
Phone (701) 780-5000

400 S Minnesota St
Crookston, MN 56716-1808
Phone (218) 281-9100

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Altru Health System Current Accepting new patients
Altru Health System CurrentSince Jun 6, 2020 Accepting new patients
Altru Health System CurrentSince Jun 6, 2020 Accepting new patients
Altru Health System CurrentSince Jun 10, 2020 Accepting new patients
Altru Health System Current Accepting new patients

Locations

400 S Minnesota St
Crookston, MN 56716
Phone (218) 281-9100

607 Demers Ave
East Grand Forks, MN 56721
Phone (218) 773-0357

19120 200th St
Greenbush, MN 56726
Phone (218) 782-2400

711 Delmore Dr
Roseau, MN 56751
Phone (218) 463-1365

412 Main Ave NE
Warroad, MN 56763
Phone (218) 386-2020

164 W 13th St
Grafton, ND 58237
Phone (701) 352-1620

1300 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 780-2300

1380 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 795-2000

2401 Demers Ave
Grand Forks, ND 58201
Phone (701) 780-1891

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 5

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": "1404950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591056000000",
    "number": "1972919942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 DEMERS AVE",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58201",
            "telephone_number": "701-780-4085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 S COLUMBIA RD",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014012",
            "telephone_number": "701-780-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AYYADURAI",
        "first_name": "PUVANALINGAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-10",
        "last_updated": "2020-06-02",
        "certification_date": "2020-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "ND",
            "license": "15887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.