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DOLORES I VAN BOURGONDIEN ANP-BC
NPI 1457788390
Nurse Practitioner - Psychiatric/Mental Health in Grand Forks, ND

Active since October 10, 2013PECOS EnrolledAccepts Medicare Assignment
3674 S WASHINGTON ST, GRAND FORKS, ND 58201(701) 205-3000(701) 732-2501 Get Directions Write a Review

NPPES record last updated: January 27, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 27, 2026, Jul 18, 2023, Nov 19, 2015 (3 updates tracked since 2015).

About Dolores I Van Bourgondien Anp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DOLORES I VAN BOURGONDIEN ANP-BC (NPI 1457788390) is an individual psychiatric/mental health provider in Grand Forks, North Dakota, licensed in North Dakota (R54243) and active in the NPI registry since October 2013. She is enrolled in Medicare PECOS, is affiliated with Sanford Medical Center Fargo, and maintains a secondary practice location in Kenai.

NPPES Registry Identity

NPI1457788390
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameDOLORES I VAN BOURGONDIENCredential: ANP-BC
Location Address3674 S WASHINGTON STGrand Forks, ND 58201-5766
Mailing AddressPo Box 5210Grand Forks, ND 58206-5210
Phone(701) 205-3000
Fax(701) 732-2501
Sole ProprietorYes
Medical School CMSOtherGraduated 2013
Enumeration DateOctober 10, 2013
Last NPPES UpdateJanuary 27, 20263 updates tracked since enumeration
NPPES CertifiedJanuary 27, 2026
✔ NPI 1457788390 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in ND · R54243
Also ListedNurse Practitioner · Adult HealthTaxonomy 363LA2200X · License ARNP9239798 (FL)
3674 S WASHINGTON ST, Grand Forks, ND 58201
Open in Google Maps ↗

Secondary Practice Location 1

Location 1508 Upland StKenai, AK 99611-8026 · Phone (907) 335-7500

Other Identifiers 2

Medicaid1695195AK
Medicaid010140700FL

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross Blue Shield of North Dakota and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dolores I Van Bourgondien Anp-bc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9032332275
PECOS Enrollment IDI20190610000219, I20200201000273, I20230512002370, I20230703001334, I20231003000399, I20241101000900
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

7

Medicare enrollment records show Dolores Van Bourgondien reassigns Medicare billing to 7 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Peterson Medical Clinics, LLC
Same address
Multi-Specialty
3674 S WASHINGTON ST
Grand Forks, ND 58201
  • Reassigned Medicare billing, Alaska, Maine, Minnesota, Montana and North Dakota enrollments
  • 70 clinicians in this Medicare group
NPI 1699295774 (701) 205-3000
Cowlitz Indian Tribe
1,217 mi
Rehabilitation, Substance Use Disorder
7105 NE 40TH ST
Vancouver, WA 98661
  • Reassigned Medicare billing, Texas enrollment
  • Medicare enrollment name: Bristol Bay Area Health Corporation
  • 360 clinicians in this Medicare group
NPI 1538412630 (360) 353-9431
Open Door Wellness LLC,
1,362 mi
Psychiatric/Mental Health
375 MAIN ST
Rockland, ME 04841
  • Reassigned Medicare billing, Maine enrollment
NPI 1841079407 (561) 866-1211
Eastern Aleutian Tribes, Inc
1,454 mi
Clinic/Center
172 MAIN STREET
Sand Point, AK 99661
  • Reassigned Medicare billing, Texas enrollment
  • 50 clinicians in this Medicare group
NPI 1346662608 (907) 383-3515
Municipality Of Skagway
1,731 mi
Federally Qualified Health Center (FQHC)
350 14TH AVENUE
Skagway, AK 99840
  • Reassigned Medicare billing, Alaska enrollment
  • 28 clinicians in this Medicare group
NPI 1063574200 (907) 983-2255
Kenaitze Indian Tribe
2,280 mi
Federally Qualified Health Center (FQHC)
206 W ROCKWELL AVE
Soldotna, AK 99669
  • Reassigned Medicare billing, Alaska enrollment
  • 40 clinicians in this Medicare group
NPI 1194603076 (907) 335-7200
Norton Sound Health Corporation
2,709 mi
Critical Access
1000 GREG KRUSCHEK AVE
Nome, AK 99762
  • Reassigned Medicare billing, Alaska enrollment
  • Also billed through NPI 1225101041 (Alaska)
  • 193 clinicians in this Medicare group
NPI 1154358232 (907) 443-3311

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
81 services23 patients
Assessment of emotional or behavioral problems 96127
Assessment of emotional or behavioral problems involves a thorough evaluation of your feelings, thoughts, and behaviors. It's a process where professionals study patterns over time to identify potential issues like anxiety, depression, or other mental health conditions.
60 services18 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Sanford Medical Center Fargo

Acute Care Hospitals · Fargo, ND
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number350011
Location801 Broadway NorthFargo, ND 58122 · Cass County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 58201 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.71 typical visit price
range $55.75 – $168.12
Typical copayment $21.42 (range $13.93 – $42.03)
Most-billed visit code 99203
Established Patient
$98.29 typical visit price
range $18.11 – $137.65
Typical copayment $24.57 (range $4.52 – $34.41)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHERBIE DARBOUZE PA-C
Physician Assistant
3674 S WASHINGTON ST
GRAND FORKS, ND 58201
Grand Forks County (701) 205-3000
MIRANDA EDEN DAVIS PMHNP
Nurse Practitioner (Psychiatric/Mental Health)
3674 S WASHINGTON ST
GRAND FORKS, ND 58201
Grand Forks County (701) 205-3000
MRS. REBECCA LYNNE OHLSON LCSW
Social Worker (Clinical)
3674 S WASHINGTON ST
GRAND FORKS, ND 58201
Grand Forks County (701) 205-3000
JALISA GILES LCSW
Social Worker (Clinical)
3674 S WASHINGTON ST
GRAND FORKS, ND 58201
Grand Forks County (701) 205-3000
GWEN LOTTA LCSW
Social Worker (Clinical)
3674 S WASHINGTON ST
GRAND FORKS, ND 58201
Grand Forks County (701) 205-3000
ASHLEY R STOWELL
Social Worker (Clinical)
3674 S WASHINGTON ST
GRAND FORKS, ND 58201
Grand Forks County (701) 205-3000
CHERYL TREDWAY LPCC, LCPC
Counselor (Professional)
3674 S WASHINGTON ST
GRAND FORKS, ND 58201
Grand Forks County (701) 205-3000
KELE FERREIRA PA-C
Physician Assistant
3674 S WASHINGTON ST
GRAND FORKS, ND 58201
Grand Forks County (701) 205-3000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dolores Van Bourgondien's NPI number?

The NPI number for Dolores Van Bourgondien is 1457788390. It was assigned to this individual provider in the NPPES registry on October 10, 2013.

Where is Dolores Van Bourgondien located?

Dolores Van Bourgondien practices at 3674 S Washington St, Grand Forks, ND 58201. The listed phone number is (701) 205-3000.

What is Dolores Van Bourgondien's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Dolores Van Bourgondien enrolled in Medicare?

Yes. Dolores Van Bourgondien is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Dolores Van Bourgondien's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Dolores Van Bourgondien reassigns Medicare benefits to 7 organizations: Peterson Medical Clinics, LLC (Grand Forks, ND), Cowlitz Indian Tribe (Vancouver, WA), Open Door Wellness LLC, (Rockland, ME), Eastern Aleutian Tribes, Inc (Sand Point, AK), Municipality Of Skagway (Skagway, AK) and 2 more organizations, listed in the Medicare section above. Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Dolores Van Bourgondien's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Dolores Van Bourgondien accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross Blue Shield of North Dakota, Blue Cross and Blue Shield of Montana, HealthPartners and Moda Health Plan, Inc. and 4 other insurers list Dolores Van Bourgondien as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Dolores Van Bourgondien affiliated with any hospitals?

According to CMS data, Dolores Van Bourgondien is affiliated with Sanford Medical Center Fargo.

When was this NPI record last updated?

The NPPES record for Dolores Van Bourgondien was last updated on January 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.