NPIMap

Individual provider Active NPI

Shreyas Sushil Shirodkar, MD

  • Internal Medicine Physician
  • Duluth, MN
National Provider Identifier
1023646023
Registry record updated Sep 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
75004 Issued in MN
Practice address
420 E 1St St
Duluth, MN 55805-1901
Phone
(218) 786-8364
Fax
(304) 598-4871
NPI assigned
Mar 27, 2020
Last updated
Sep 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 75004 MN Primary

Addresses

Primary practice location

420 E 1St St
Duluth, MN 55805-1901

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, WV2 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
I20231026000938 MN Practitioner - Internal Medicine 8426404559 Reassigns benefits to 1 organization
I20240826002348 WV Practitioner - Internal Medicine 8426404559 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rutgers New Jersey Medical School, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

501 Morris St
Charleston, WV 25301-1326
Phone (304) 388-7823

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
75004MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center, Inc. CurrentSince Aug 19, 2024 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
The Duluth Clinic, LTD. CurrentSince Sep 18, 2023 Accepting new patients
Charleston Area Medical Center Inc CurrentSince Aug 19, 2024 Accepting new patients
The Duluth Clinic LTD CurrentSince Sep 18, 2023 Accepting new patients
Charleston Area Medical Center Inc Past Accepting new patients

Locations

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

420 E 1st St
Duluth, MN 55805
Phone (218) 786-1265

4855 W Arrowhead Rd
Hermantown, MN 55811
Phone (218) 786-3540

3200 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 388-2550

400 Association Dr
Ste 102
Charleston, WV 25311
Phone (304) 388-1762

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

Organizations & group practices 6

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.

Hospital & facility affiliations 11

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": "1585267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695772800000",
    "number": "1023646023",
    "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": "420 E 1ST ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051901",
            "telephone_number": "218-786-8364",
            "fax_number": "304-598-4871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIRODKAR",
        "first_name": "SHREYAS",
        "middle_name": "SUSHIL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-27",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "75004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.