NPIMap

Individual provider Active NPI

Georgia Dimos Brunette

  • Internal Medicine Physician
  • Superior, WI
National Provider Identifier
1043255342
Registry record updated May 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
41637-021 Issued in WI
Practice address
3500 Tower Ave
Superior, WI 54880-5335
Phone
(715) 395-5454
NPI assigned
Jun 19, 2006
Last updated
May 9, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2011

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 41637-021 WI Primary

Addresses

Primary practice location

3500 Tower Ave
Superior, WI 54880-5335

Mailing address

3500 Tower Ave
Superior, WI 54880-5335
Phone (715) 395-5454

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060825000038 WI Practitioner - Emergency MedicinePractitioner - Internal Medicine 0648273011 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Michigan State University College of Osteopathic Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians
St Marys Hospital of SuperiorGroup PAC ID 8628964228, 96 clinicians

Practice addresses (Care Compare)

1600 Miller Trunk Hwy
BLDG C
Duluth, MN 55811-5640
Phone (218) 786-5360

3500 Tower Ave
Superior, WI 54880-4491
Phone (715) 392-8281

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41637-021WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary's Hospital of Superior Current Accepting new patients
St. Mary's Duluth Clinic Health System Current Accepting new patients
St Mary's Hospital of Superior CurrentSince Mar 1, 2020 Accepting new patients
St. Mary's Hospital of Superior CurrentSince Mar 1, 2020 Accepting new patients
The Duluth Clinic, LTD. Past Accepting new patients

Locations

4855 W Arrowhead Rd
#3764
Hermantown, MN 55811
Phone (218) 725-3540

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

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

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

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 8

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": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304899200000",
    "number": "1043255342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 TOWER AVE",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548805335",
            "telephone_number": "715-395-5454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 TOWER AVE",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548805335",
            "telephone_number": "715-395-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNETTE",
        "first_name": "GEORGIA",
        "middle_name": "DIMOS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-19",
        "last_updated": "2011-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "41637-021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Superior, WI

Sources for this page

Verify at the official NPI Registry.