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MALLORY HESTDALEN
NPI 1851752885
Nurse Practitioner - Neonatal in Fargo, ND

Active since March 18, 2016PECOS Enrolled
801 BROADWAY N, FARGO, ND 58102(701) 234-2000 Get Directions Write a Review

NPPES record last updated: September 29, 2020. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Sep 29, 2020, Mar 18, 2016 (2 updates tracked since 2016).

About Mallory Hestdalen NPPES

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

MALLORY HESTDALEN (NPI 1851752885) is an individual neonatal provider in Fargo, North Dakota, licensed in North Dakota (R33463) and active in the NPI registry since March 2016. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1851752885
Entity TypeIndividualFemale
Primary Taxonomy363LN0000X
Provider Legal NameMALLORY HESTDALEN
Location Address801 BROADWAY NFargo, ND 58102-3641
Mailing AddressPo Box 5074Sioux Falls, SD 57117-5074
Phone(701) 234-2000
Sole ProprietorNo
Enumeration DateMarch 18, 2016
Last NPPES UpdateSeptember 29, 20202 updates tracked since enumeration
NPPES CertifiedSeptember 29, 2020
✔ NPI 1851752885 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · NeonatalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LN0000X
License✔ Licensed in ND · R33463
Also ListedRegistered NurseTaxonomy 163W00000X · License R33463 (ND)
801 BROADWAY N, Fargo, ND 58102
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross Blue Shield of North Dakota, Sanford Health Plan.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mallory Hestdalen is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 Reassignment

Medicare enrollment records show Mallory Hestdalen reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Innovis Health LLC
1.4 mi
Occupational Medicine
1100 19TH AVE N, SUITE L & M
Fargo, ND 58102
  • Reassigned Medicare billing, North Dakota enrollment
  • 617 clinicians in this Medicare group
NPI 1568918902 (701) 356-1150

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 58102 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.

SARAH HOEPFNER
Speech-Language Pathologist
801 BROADWAY N
FARGO, ND 58102
Cass County (701) 234-6970
JULIE HONEYMAN CRNA
Nurse Anesthetist, Certified Registered
801 BROADWAY N
FARGO, ND 58102
Cass County (701) 234-6355
SANFORD MEDICAL CENTER FARGO
Hospice Care, Community Based
801 BROADWAY N
FARGO, ND 58102
Cass County (701) 234-5264
DOUGLAS J HUSHKA MD
Family Medicine
801 BROADWAY N
FARGO, ND 58102
Cass County (701) 234-6552
PAUL JAMES CARSON MD
Internal Medicine (Infectious Disease)
801 BROADWAY N
FARGO, ND 58102
Cass County (701) 234-4811
DR. EMUEJEVOKE JOSEPH OKOH M.D.
Internal Medicine (Gastroenterology)
801 BROADWAY N
FARGO, ND 58102
Cass County (701) 234-2000
WALDEMAR G STORM MD
Pediatrics
801 BROADWAY N
FARGO, ND 58102
Cass County (701) 234-2261
GREGORY J BJERKE MD
Internal Medicine
801 BROADWAY N
FARGO, ND 58102
Cass County (701) 234-5123

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 Mallory Hestdalen's NPI number?

The NPI number for Mallory Hestdalen is 1851752885. It was assigned to this individual provider in the NPPES registry on March 18, 2016.

Where is Mallory Hestdalen located?

Mallory Hestdalen practices at 801 Broadway N, Fargo, ND 58102. The listed phone number is (701) 234-2000.

What is Mallory Hestdalen's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Neonatal, with taxonomy code 363LN0000X.

Is Mallory Hestdalen enrolled in Medicare?

Yes. Mallory Hestdalen is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Mallory Hestdalen's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mallory Hestdalen reassigns Medicare benefits to Innovis Health LLC (Fargo, ND). The 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 Mallory Hestdalen's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Mallory Hestdalen accept?

Health plans from Blue Cross Blue Shield of North Dakota and Sanford Health Plan list Mallory Hestdalen 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.

When was this NPI record last updated?

The NPPES record for Mallory Hestdalen was last updated on September 29, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years 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.