NPIMap

Individual provider Active NPI

Colton David Wiesner, MD

  • Emergency Medicine Physician
  • Duluth, MN
National Provider Identifier
1023645678
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
74426 Issued in MN
Practice address
402 E 2ND St
Duluth, MN 55805-1906
Phone
(218) 786-4000
NPI assigned
Mar 24, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 74426 MN Primary

Addresses

Primary practice location

402 E 2ND St
Duluth, MN 55805-1906

Mailing address

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

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
I20230913001758 MN Practitioner - Emergency Medicine 6709209208 Reassigns benefits to 10 organizations
I20230913002509 WI Practitioner - Emergency Medicine 6709209208 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Medical College of Wisconsin, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Medical CenterGroup PAC ID 6901706357, 91 clinicians
Northern Pines Medical CenterGroup PAC ID 3870565641, shared by 4 NPIs, 39 clinicians

Practice addresses (Care Compare)

402 E 2ND St
Duluth, MN 55805-1906
Phone (218) 786-4000

5211 Hwy 110
Aurora, MN 55705-1522
Phone (218) 229-3311

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
74426MNMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Essentia Health Virginia, LLC CurrentSince Aug 28, 2023 Accepting new patients
St. Mary's Hospital of Superior CurrentSince Aug 28, 2023 Accepting new patients
St. Mary's Medical Center CurrentSince Aug 28, 2023 Accepting new patients
Essentia Health Moose Lake CurrentSince Aug 28, 2023 Accepting new patients
Essentia Health Moose Lake CurrentSince Aug 28, 2023 Accepting new patients
Deer River Healthcare Center, Inc. CurrentSince Aug 28, 2023 Accepting new patients
Northern Pines Medical Center Current Accepting new patients
Deer River Healthcare Center, Inc CurrentSince Aug 28, 2023 Accepting new patients
Northern Pines Medical Center CurrentSince Aug 28, 2023 Accepting new patients
Essentia Health Virginia, LLC CurrentSince Aug 28, 2023 Accepting new patients
St. Mary's Duluth Clinic Health System Current Accepting new patients
St. Mary's Hospital of Superior CurrentSince Aug 28, 2023 Accepting new patients
Moose Lake Community Hospital District Current Accepting new patients
Deer River Healthcare Center, Inc. Current Accepting new patients
St Marys Medical Center CurrentSince Aug 28, 2023 Accepting new patients

Locations

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

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

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

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

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

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

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

Organizations & group practices 16

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 16

Hospital & facility affiliations 9

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": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1023645678",
    "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": "402 E 2ND ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051906",
            "telephone_number": "218-786-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESNER",
        "first_name": "COLTON",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-24",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "74426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.