NPIMap

Individual provider Active NPI

Sara Lynne Simonson, PA-C

  • Physician Assistant
  • Duluth, MN
National Provider Identifier
1053565861
Registry record updated Feb 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2300 Issued in MN
Practice address
1012 E 2ND St
Duluth, MN 55805-2200
Phone
(218) 249-2450
Fax
(218) 249-2451
NPI assigned
Nov 6, 2008
Last updated
Feb 3, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2300 MN Primary
Occupational Therapist 225X00000X 103577 MN

Addresses

Primary practice location

1012 E 2ND St
Duluth, MN 55805-2200

Mailing address

1012 E 2ND St
Duluth, MN 55805-2200
Phone (218) 249-2450

Other names 1

  • Sara Lynne Boyle Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20150812007165 MN Practitioner - Physician Assistant 8628383288 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Luke's Hospital of DuluthGroup PAC ID 7113834839, 409 clinicians

Practice addresses (Care Compare)

1011 E 1St St
Duluth, MN 55805-2242
Phone (218) 249-7000

1015 E 1St St
Duluth, MN 55805-2242
Phone (218) 249-7860

915 E 1St St
Duluth, MN 55805-2107
Phone (218) 249-5439

920 E 1St St
Duluth, MN 55805-2225

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2300MNMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke's Hospital of Duluth CurrentSince Jul 21, 2015 Accepting new patients
St. Luke's Hospital of Duluth CurrentSince Jul 21, 2015 Accepting new patients
St. Luke's Hospital of Duluth Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860

915 E 1st St
Duluth, MN 55805
Phone (218) 249-5352

Interoperability endpoints

  • Direct secure messaging: ssimonson352092@direct.aspirus.org

Organizations & group practices 4

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 29

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1225929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486080000000",
    "number": "1053565861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 E 2ND ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052200",
            "telephone_number": "218-249-2450",
            "fax_number": "218-249-2451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 E 2ND ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052200",
            "telephone_number": "218-249-2450",
            "fax_number": "218-249-2451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMONSON",
        "first_name": "SARA",
        "middle_name": "LYNNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-06",
        "last_updated": "2017-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "2300",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "103577",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARA",
            "last_name": "BOYLE",
            "middle_name": "LYNNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.