Individual provider Active NPI

Brian Wasserman, MD

  • Psychiatry Physician
  • Duluth, MN
National Provider Identifier
1053739482
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
67277 Issued in MN
Practice address
400 E 3Rd St
Duluth, MN 55805-1951
Phone
(218) 786-8364
NPI assigned
Apr 2, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 67277 MN Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

400 E 3Rd St
Duluth, MN 55805-1951

Mailing address

400 E 3Rd St
Duluth, MN 55805-1951

Other practice location 1

2301 Erwin Rd
Durham, NC 27710
Phone (919) 684-8111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200912000018 MN Practitioner - PsychiatryPractitioner - Hospitalist 5597183210 Reassigns benefits to 1 organization
I20240327000316 WI Practitioner - Psychiatry 5597183210 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
PsychiatryAlso: Hospitalist
Education
University of Miami, LM Miller School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

4621 E Superior St
Duluth, MN 55804-2338
Phone (218) 786-3550

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
67277MNMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Duluth Clinic, LTD Current Accepting new patients
St. Mary'S Hospital of Superior CurrentSince Feb 1, 2024 Accepting new patients
St. Mary'S Hospital of Superior Current Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
The Duluth Clinic LTD CurrentSince Sep 8, 2020 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Sep 8, 2020 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients

Locations

1502 London Rd
Ste 102
Duluth, MN 55812
Phone (218) 576-0100

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

4212 Grand Ave
Duluth, MN 55807
Phone (218) 786-3500

4621 E Superior St
Duluth, MN 55804
Phone (218) 786-3550

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

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1396396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599091200000",
    "number": "1053739482",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2301 Erwin Rd",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "27710",
            "country_code": "US",
            "telephone_number": "919-684-8111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WASSERMAN",
        "first_name": "BRIAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-02",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "67277",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.