Georgia Dimos Brunette
Individual provider Active NPI Internal Medicine Physician · Superior, WI
NPI 1043255342 · NPPES record last updated May 9, 2011
Key facts
- NPI
- 1043255342
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 41637-021 (WI)
- Practice address
- 3500 Tower Ave
Superior, WI 54880-5335 - Phone
- (715) 395-5454
- NPI assigned
- Jun 19, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 8
Medicare Care Compare profile
- 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 Center
St Marys Hospital of Superior
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
- Aveanna Home Health
- Centerwell Home Health
- Avanti Home Care
- St Marys Hospital Superior
- Essentia Health St Mary'S Medical Center
- Essentia Health Duluth
- Tamarack Health Hayward Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060825000038 | WI | Practitioner - Emergency Medicine |
0648273011 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41637-021 | WI | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Mary'S Hospital of Superior | Current |
Accepting new 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 | Current |
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
#1
Superior, WI 54880
Phone (715) 395-5457
3500 Tower Ave
Ste 1
Superior, WI 54880
Phone (715) 395-5457
3500 Tower Ave
Superior, WI 54880
Phone (715) 392-8281
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 41637-021 | WI | Yes |
Addresses
Primary practice location
3500 Tower Ave
Superior, WI 54880-5335
Mailing address
3500 Tower Ave
Superior, WI 54880-5335
Phone (715) 395-5454
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30096700 | Medicaid | WI |
Other providers in Superior, WI
- Leslie S. L. Broad
- Clifford William Bronniche
- Ivie Brooks
- Kacy Lynn Broschofsky
- Kevin Michael Brown
- Robert A. Bukowski
- Jennifer Ann Bulin
- Ellen Bursch
- Elizabeth B Byler
- Jarret S Byrnes
All providers in Superior, WI · Internal Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.