NPIMap

Individual provider Active NPI

Blake Ervin Collison, MD

  • Emergency Medicine Physician
  • Duluth, MN
National Provider Identifier
1003293804
Registry record updated Jun 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
63874 Issued in MN
Practice address
407 E 3Rd St
Duluth, MN 55805
Phone
(218) 786-4000
NPI assigned
Apr 30, 2015
Last updated
Jun 22, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2018

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
Emergency Medicine Physician 207P00000X 63874 MN Primary

Addresses

Primary practice location

407 E 3Rd St
Duluth, MN 55805

Mailing address

1702 University Dr S
Fargo, ND 58103-4940
Phone (701) 364-4222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180718000091 MN Practitioner - Emergency Medicine 8325340474 Reassigns benefits to 10 organizations
I20180719000810 WI Practitioner - Emergency Medicine 8325340474 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Minnesota, Duluth School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians

Practice addresses (Care Compare)

1600 Miller Trunk Hwy
Duluth, MN 55811-5640
Phone (218) 786-5360

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Deer River Healthcare Center Inc CurrentSince Jul 30, 2018 Accepting new patients
Essentia Health Virginia, LLC CurrentSince Jul 30, 2018 Accepting new patients
St. Mary's Hospital of Superior Current Accepting new patients
Essentia Health Moose Lake CurrentSince May 17, 2021 Accepting new patients
St. Mary's Duluth Clinic Health System Current Accepting new patients
Deer River Healthcare Center, Inc. CurrentSince Jul 30, 2018 Accepting new patients
Deer River Healthcare Center, Inc. Current Accepting new patients
Essentia Health Moose Lake CurrentSince May 17, 2021 Accepting new patients
Northern Pines Medical Center CurrentSince Jul 30, 2018 Accepting new patients
Pine Medical Center CurrentSince Nov 12, 2018 Accepting new patients
Essentia Health Virginia, LLC CurrentSince Jul 30, 2018 Accepting new patients
St Marys Medical Center CurrentSince Jul 30, 2018 Accepting new patients
Deer River Healthcare Center, Inc CurrentSince Jan 1, 2026 Accepting new patients
St. Mary's Hospital of Superior CurrentSince Jul 30, 2018 Accepting new patients
Northern Pines Medical Center CurrentSince Jan 1, 2026 Accepting new patients
Pine Medical Center CurrentSince Nov 12, 2018 Accepting new patients
St. Mary's Medical Center CurrentSince Jul 30, 2018 Accepting new patients
Moose Lake Community Hospital District Current Accepting new patients

Locations

5211 Highway 110
Aurora, MN 55705
Phone (218) 229-1010

115 10th Ave NE
Deer River, MN 56636
Phone (218) 246-2900

115 10th Ave NE
#A
Deer River, MN 56636
Phone (218) 246-8275

402 E 2nd St
Duluth, MN 55805
Phone (218) 786-3443

407 E 3rd St
Duluth, MN 55805
Phone (218) 786-4357

4572 County Road 61
Moose Lake, MN 55767
Phone (218) 485-4481

705 Lundorff Dr
Sandstone, MN 55072
Phone (320) 245-2211

901 9th St N
Virginia, MN 55792
Phone (218) 741-3340

1702 University Dr S
Fargo, ND 58103
Phone (701) 364-4222

3500 Tower Ave
Superior, WI 54880
Phone (715) 392-8281

Organizations & group practices 19

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.

View all 19

Hospital & facility affiliations 7

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": "1430352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529625600000",
    "number": "1003293804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940",
            "telephone_number": "701-364-4222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "55805",
            "telephone_number": "218-786-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLISON",
        "first_name": "BLAKE",
        "middle_name": "ERVIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-30",
        "last_updated": "2018-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "63874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.