NPIMap

Individual provider Active NPI

Bruce James Derauf

  • Diagnostic Radiology Physician
  • Duluth, MN
National Provider Identifier
1003847385
Registry record updated May 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
32484 Issued in MN
Practice address
400 E 3Rd St
Duluth, MN 55805-1951
Phone
(218) 786-8364
NPI assigned
Jul 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 32484 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) 786-8364

Other identifiers 1

IdentifierTypeStateIssuer
269300300MedicaidMN

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
I20041103000200 MN Practitioner - Diagnostic Radiology 9133181969 Reassigns benefits to 2 organizations
I20150203000515 WI Practitioner - Diagnostic Radiology 9133181969 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, shared by 25 NPIs, 1,135 clinicians

Practice addresses (Care Compare)

15495 County Rd B
Hayward, WI 54843-3438
Phone (715) 634-2641

1615 Maple LN
Suite 1
Ashland, WI 54806-3630
Phone (715) 685-7500

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

420 E 1St St
Duluth, MN 55805-1901
Phone (218) 786-8364

Hospital & facility affiliations

  • Essentia Health Duluth Hospital, Duluth, MN, CCN 240019
  • St Marys Hospital Superior Hospital, Superior, WI, CCN 521329
  • Essentia Health St Mary'S Medical Center Hospital, Duluth, MN, CCN 240002
  • Ely - Bloomenson Community Hospital Hospital, Ely, MN, CCN 241318
  • Tamarack Health Hayward Medical Center Hospital, Hayward, WI, CCN 521336

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
32484MNMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary'S Duluth Clinic Health System Current Accepting new patients
Brainerd Medical Center Inc CurrentSince Jul 1, 2022 Accepting new patients
The Duluth Clinic, LTD CurrentSince Nov 18, 2014 Accepting new patients
St. Mary'S Hospital of Superior Current Accepting new patients
The Duluth Clinic, LTD CurrentSince Oct 1, 1994 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Oct 1, 1994 Accepting new patients
Brainerd Medical Center Inc. CurrentSince Jul 1, 2022 Accepting new patients
St. Mary'S Hospital of Superior CurrentSince Aug 15, 2018 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients

Locations

13060 Isle Dr
Brainerd, MN 56425
Phone (218) 454-5920

2024 S 6th St
Brainerd, MN 56401
Phone (218) 828-2880

324 W Superior St
Ste 824
Duluth, MN 55802
Phone (218) 722-3185

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

15495 County Road B
Hayward, WI 54843
Phone (715) 634-2641

3500 Tower Ave
Ste 1
Superior, WI 54880
Phone (715) 395-5457

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

Organizations & group practices 9

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.

Hospital & facility affiliations 6

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305763200000",
    "number": "1003847385",
    "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": "218-786-8364"
        },
        {
            "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": "218-786-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERAUF",
        "first_name": "BRUCE",
        "middle_name": "JAMES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2011-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "32484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269300300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.