Active NPI
Jordan Tichenor
- Infectious Disease Physician
- Duluth, MN
National Provider Identifier
1003299827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Infectious Disease Physician
- License
- 71017
- Practice address
- 400 E 3Rd St
Duluth, MN 55805-1951 - Phone
- (218) 786-3737
- Fax
- (187) 278-3282
- NPI assigned
- Jun 30, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Infectious Diseases Pharmacist | 1835I0206X | 77711 | WI | |
| Infectious Disease Physician | 207RI0200X | 71017 | MN | Primary |
Addresses
Primary practice location
400 E 3Rd St
Duluth, MN 55805-1951
Mailing address
400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8895
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220718001778 | MN | Practitioner - Infectious Disease | 7315253713 |
Care Compare profile
Medicare Care Compare- Specialty
- Infectious Disease
- Education
- Lincoln Memorial University Medical Department, 2015
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
400 E 3Rd St
Duluth, MN 55805-1951
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 77711 | WI | MD | Medical license number |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Duluth Clinic, LTD. | Current | Accepting new patients | |
| The Duluth Clinic LTD | Current | Accepting new patients | |
| The Duluth Clinic LTD | Current | Accepting new patients |
Locations
400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Essentia Health Orthopedic Urgent Care
- Urgent Care Clinic/Center
- Duluth, MN
- NPI 1902459209
-
dba Essentia Health Cloquet Clinic
- Multi-Specialty Clinic/Center
- Cloquet, MN
- NPI 1902563638
-
dba Essentia Health Hinckley Pharmacy
- Community/Retail Pharmacy
- Hinckley, MN
- NPI 1245081066
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Essentia Health Virginia
- General Acute Care Hospital
- Virginia, MN
- NPI 1083617120
-
dba Essentia Health St Marys Medical Center
- General Acute Care Hospital
- Duluth, MN
- NPI 1457393035
-
dba Tamarack Health Hayward Medical Center
- Critical Access Hospital
- Hayward, WI
- NPI 1912992827
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715040000000",
"number": "1003299827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 E 3RD ST",
"city": "DULUTH",
"state": "MN",
"postal_code": "558051951",
"telephone_number": "218-786-8895",
"fax_number": "218-727-8328"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 E 3RD ST",
"city": "DULUTH",
"state": "MN",
"postal_code": "558051951",
"telephone_number": "218-786-3737",
"fax_number": "187-278-3282"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TICHENOR",
"first_name": "JORDAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-06-30",
"last_updated": "2024-05-07",
"certification_date": "2024-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "1835I0206X",
"taxonomy_group": "",
"desc": "Pharmacist, Infectious Diseases",
"state": "WI",
"license": "77711",
"primary": false
},
{
"code": "207RI0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Infectious Disease",
"state": "MN",
"license": "71017",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Duluth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.