NPIMap

Organization Active NPI

Advanced Surgical Associates of Northern Minnesota PLLC

  • Surgery Physician
  • Hibbing, MN
National Provider Identifier
1033725197
Registry record updated Jul 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
ADVANCED SURGICAL ASSOCIATES OF NORTHERN MINNESOTA PLLC
Practice address
4325 9TH Ave W
Hibbing, MN 55746-3032
Phone
(218) 461-2122
NPI assigned
Sep 23, 2020
Last updated
Jul 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2021

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

Authorized official

Name
Dr. John P Bollins, DONPI 1255461745
Title
DO/Owner
Phone
(218) 461-2212

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

4325 9TH Ave W
Hibbing, MN 55746-3032

Mailing address

PO Box 15042
Duluth, MN 55815-0042

Other practice location 1

1420 London Rd Ste 101
Duluth, MN 55805-2437
Phone (218) 461-2122

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210114000552 MN Part B Supplier - Clinic/Group Practice 6204249188 Receives reassigned benefits from 1 practitioner
Practice locations: Duluth, MN; Hibbing, MN

National Provider Directory

National Provider Directory

Locations

1420 London Rd
Ste 101
Duluth, MN 55805
Phone (218) 461-2122

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22569/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625270400000",
    "number": "1033725197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15042",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558150042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4325 9TH AVE W",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557463032",
            "telephone_number": "218-461-2122"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1420 London Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558052437",
            "country_code": "US",
            "telephone_number": "218-461-2122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADVANCED SURGICAL ASSOCIATES OF NORTHERN MINNESOTA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-23",
        "last_updated": "2021-07-03",
        "certification_date": "2021-07-03",
        "status": "A",
        "authorized_official_last_name": "BOLLINS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "DO/OWNER",
        "authorized_official_telephone_number": "218-461-2212",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hibbing, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.