| Prairie St John's | |
|
510 4th St S Fargo ND 58103 | |
| (701) 476-7200 | |
| (701) 280-5789 |
| Full Name | Prairie St John's |
|---|---|
| Speciality | Psychiatric Hospital |
| Location | 510 4th St S, Fargo, North Dakota |
| Authorized Official Name and Position | Steve Filton (SRVP CFO) |
| Authorized Official Contact | 6107683300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie St John's 510 4th St S Fargo ND 58103 Ph: (701) 476-7200 | Prairie St John's 510 4th St S Fargo ND 58103 Ph: (701) 476-7200 |
| NPI Number | 1679709802 |
|---|---|
| Provider Enumeration Date | 06/02/2009 |
| Last Update Date | 04/29/2024 |
| Certification Date | 04/29/2024 |
| Medicare PECOS PAC ID | 7012062235 |
|---|---|
| Medicare Enrollment ID | O20090918000240 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679709802 | NPI | - | NPPES |
| 11051 | Medicaid | ND | |
| 99725100 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| 283Q00000X | Psychiatric Hospital | (* (Not Available)) | Primary |
| Provider Name | Tamara M Madler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053474411 PECOS PAC ID: 0648162024 Enrollment ID: I20040329001428 |
| Provider Name | Fetih Akgul |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093807182 PECOS PAC ID: 8224057724 Enrollment ID: I20051114001098 |
| Provider Name | Carole Y Halone |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144323700 PECOS PAC ID: 7719089457 Enrollment ID: I20070226000787 |
| Provider Name | David J Mach |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497945158 PECOS PAC ID: 8123114337 Enrollment ID: I20071019000115 |
| Provider Name | Charlotte A Siemens |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285664169 PECOS PAC ID: 1456447333 Enrollment ID: I20071024000121 |
| Provider Name | Charlotte M Andersen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023111606 PECOS PAC ID: 3779512678 Enrollment ID: I20071112000577 |
| Provider Name | Gina Marie Cook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063696425 PECOS PAC ID: 9537218029 Enrollment ID: I20090512000224 |
| Provider Name | Jenny K Frissell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467555078 PECOS PAC ID: 5698811925 Enrollment ID: I20090930000189 |
| Provider Name | Booker T Evans |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093756736 PECOS PAC ID: 2769495050 Enrollment ID: I20091118000258 |
| Provider Name | Cheryl A Sartain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255648051 PECOS PAC ID: 2163619784 Enrollment ID: I20101208001249 |
| Provider Name | Tim A Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881821619 PECOS PAC ID: 1254517113 Enrollment ID: I20130102000442 |
| Provider Name | Donald E Wiger |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427285253 PECOS PAC ID: 1052565488 Enrollment ID: I20130211000574 |
| Provider Name | Rachel Kvasager |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134468192 PECOS PAC ID: 1456598499 Enrollment ID: I20130510000074 |
| Provider Name | Jacqualine Gervais |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336481803 PECOS PAC ID: 1658519632 Enrollment ID: I20130603000617 |
| Provider Name | Lacey L Armstrong |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942520325 PECOS PAC ID: 8628218658 Enrollment ID: I20130715000639 |
| Provider Name | Steven Meek |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093005639 PECOS PAC ID: 6709013766 Enrollment ID: I20140708000857 |
| Provider Name | Anthony Vaca |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700858248 PECOS PAC ID: 8123038023 Enrollment ID: I20140910000601 |
| Provider Name | Nivedita S Nadkarni |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346479185 PECOS PAC ID: 3173752912 Enrollment ID: I20140917003125 |
| Provider Name | Nils-erik J Juanto Laver |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1306274600 PECOS PAC ID: 3476772708 Enrollment ID: I20140917003166 |
| Provider Name | Matthew A Mcdougall |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730446204 PECOS PAC ID: 0840420675 Enrollment ID: I20141024000220 |
| Provider Name | Daniel A Danczyk |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639303894 PECOS PAC ID: 8224210141 Enrollment ID: I20141119000313 |
| Provider Name | Kathryn A Ney |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154366144 PECOS PAC ID: 5799959532 Enrollment ID: I20150318002289 |
| Provider Name | Kari Dubosque |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235496191 PECOS PAC ID: 3476864166 Enrollment ID: I20150622002441 |
| Provider Name | Amy J Lavalla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215312236 PECOS PAC ID: 8224344890 Enrollment ID: I20150826002869 |
| Provider Name | Samardeep K Randhawa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265723134 PECOS PAC ID: 8224268057 Enrollment ID: I20150923001421 |
| Provider Name | Andrea Jean Nelsen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043442700 PECOS PAC ID: 0749423770 Enrollment ID: I20151029002799 |
| Provider Name | Susan Elaine Cassatt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831379767 PECOS PAC ID: 3476630252 Enrollment ID: I20151113002318 |
| Provider Name | Ellen Elaine Tinsley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578833828 PECOS PAC ID: 3375706708 Enrollment ID: I20160127000303 |
| Provider Name | Amy Ulbricht |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972862332 PECOS PAC ID: 7810286945 Enrollment ID: I20160512002325 |
| Provider Name | Stephen C Williams |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184778284 PECOS PAC ID: 2961440391 Enrollment ID: I20160513001065 |
| Provider Name | Brenda R. Collins |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1750730966 PECOS PAC ID: 1850684796 Enrollment ID: I20160729000642 |
| Provider Name | Soha Alammoury |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750730834 PECOS PAC ID: 1557655859 Enrollment ID: I20160809003113 |
| Provider Name | Ashley C Bishop |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043763220 PECOS PAC ID: 4688960412 Enrollment ID: I20160902002002 |
| Provider Name | Balwinder Singh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588001671 PECOS PAC ID: 3971899659 Enrollment ID: I20160906002080 |
| Provider Name | Eric John Monticello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558816306 PECOS PAC ID: 4688961980 Enrollment ID: I20160930000877 |
| Provider Name | Catherine R Mier |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386087765 PECOS PAC ID: 6002195369 Enrollment ID: I20161109002890 |
| Provider Name | Ryan T Santin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649698523 PECOS PAC ID: 1658590088 Enrollment ID: I20161121000769 |
| Provider Name | Eric C Tee |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487075404 PECOS PAC ID: 8820380603 Enrollment ID: I20170406001231 |
| Provider Name | Derek M Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548607690 PECOS PAC ID: 6507172509 Enrollment ID: I20170419002703 |
| Provider Name | Roderick Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861917882 PECOS PAC ID: 0941575484 Enrollment ID: I20171113003238 |
| Provider Name | Heather J Berney |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568859809 PECOS PAC ID: 5294093472 Enrollment ID: I20171215002010 |
| Provider Name | Tymberly S Seim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356736896 PECOS PAC ID: 7113206996 Enrollment ID: I20180309002315 |
| Provider Name | Ryan Greene |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104231505 PECOS PAC ID: 2668691700 Enrollment ID: I20180604002590 |
| Provider Name | Lisa M Schock |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548640949 PECOS PAC ID: 2668729328 Enrollment ID: I20180726000696 |
| Provider Name | Timothy S Fuchs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740410810 PECOS PAC ID: 5193981249 Enrollment ID: I20181119002559 |
| Provider Name | Maryn Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073089439 PECOS PAC ID: 9436498789 Enrollment ID: I20190304001121 |
| Provider Name | Shama Rathi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427493972 PECOS PAC ID: 9931441003 Enrollment ID: I20190422001913 |
| Provider Name | John A Person |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770018228 PECOS PAC ID: 4880964634 Enrollment ID: I20190918000760 |
| Provider Name | Anna E Statz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235662982 PECOS PAC ID: 6608146451 Enrollment ID: I20191011001012 |
| Provider Name | Courtnee Renee Heyduk |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568967446 PECOS PAC ID: 7315294964 Enrollment ID: I20200506003387 |
| Provider Name | Ebony S Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336484542 PECOS PAC ID: 1557599354 Enrollment ID: I20200507000309 |
| Provider Name | Haley Faye Wahl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669017265 PECOS PAC ID: 7618398694 Enrollment ID: I20200529000236 |
| Provider Name | Tracy K Fiser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154711943 PECOS PAC ID: 6406172014 Enrollment ID: I20200529001363 |
| Provider Name | Abby Fredrickson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376063370 PECOS PAC ID: 0547685125 Enrollment ID: I20200721002823 |
| Provider Name | Rachel D Barnick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841817384 PECOS PAC ID: 7810315447 Enrollment ID: I20210707003956 |
| Provider Name | Amber M Olson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003377649 PECOS PAC ID: 3577899152 Enrollment ID: I20210917002464 |
| Provider Name | Emily Volesky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609546555 PECOS PAC ID: 2961890041 Enrollment ID: I20211021002130 |
| Provider Name | Carol A Whitman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346861473 PECOS PAC ID: 4981021805 Enrollment ID: I20211220002542 |
| Provider Name | Sarah L Abbott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396402475 PECOS PAC ID: 1557754439 Enrollment ID: I20220217001765 |
| Provider Name | Kenneth Troxclair |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902466436 PECOS PAC ID: 0840686960 Enrollment ID: I20220329002496 |
| Provider Name | Jessie M Kier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538817259 PECOS PAC ID: 7810384823 Enrollment ID: I20220421001224 |
| Provider Name | Molly Wambach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558931097 PECOS PAC ID: 3375929904 Enrollment ID: I20221004003520 |
| Provider Name | Kesley C Pike |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891350351 PECOS PAC ID: 8628304284 Enrollment ID: I20221201000915 |
| Provider Name | Christopher J Clark |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770084634 PECOS PAC ID: 8325462872 Enrollment ID: I20221201001543 |
| Provider Name | Sarah A Terpstra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467164012 PECOS PAC ID: 4587038120 Enrollment ID: I20230321002398 |
| Provider Name | Arpit Heer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861069833 PECOS PAC ID: 1052769163 Enrollment ID: I20231130001200 |
| Provider Name | Luke T Mike |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437726304 PECOS PAC ID: 6305294190 Enrollment ID: I20231205001800 |
| Provider Name | Joshua S Reider |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053055111 PECOS PAC ID: 9032590906 Enrollment ID: I20240118003762 |
Insight Counseling Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1330 Page Dr S Ste 202a, Fargo, ND 58103 Phone: 701-367-5985 Fax: 701-353-2080 | |
Child And Family Therapy Associates Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1121 Westrac Dr S Ste 204, Fargo, ND 58103 Phone: 701-893-3419 Fax: 701-356-8801 | |
Fraser, Ltd. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2902 University Dr S, Fargo, ND 58103 Phone: 701-232-3301 Fax: 701-237-5775 | |
Sanford Neuroscience Clinic Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 700 1st Ave S, Fargo, ND 58103 Phone: 701-234-4036 Fax: 701-234-4134 | |
Shanti Wellness Pllc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 3481 University Dr S Ste 104, Fargo, ND 58104 Phone: 701-353-9238 Fax: 701-205-1221 | |
Path Minnesota, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1202 Westrac Dr S Ste 400, Fargo, ND 58103 Phone: 701-280-9545 Fax: 701-451-9473 | |
Forest River Counseling Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3523 45th St S, Fargo, ND 58104 Phone: 701-793-5400 |