NPIMap

Individual provider Active NPI

Conrad Joseph Ross, PA-C

  • Medical Physician Assistant
  • Duluth, MN
National Provider Identifier
1093779852
Registry record updated Apr 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
9581 Issued in MN
Practice address
400 E 3Rd St
Maildrop: 1S2W50
Duluth, MN 55805-1951
Phone
(218) 786-3985
Fax
(218) 786-3018
NPI assigned
Apr 17, 2006
Last updated
Apr 29, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 9581 MN Primary

Addresses

Primary practice location

400 E 3Rd St
Maildrop: 1S2W50
Duluth, MN 55805-1951

Mailing address

4687 County Road 13
Moose Lake, MN 55767-8109
Phone (218) 485-4479

Other identifiers 2

IdentifierTypeStateIssuer
659411500MedicaidMN
41921600MedicaidWI

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
I20100427000860 MN Practitioner - Physician Assistant 4789711565 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Marys Hospital of SuperiorGroup PAC ID 8628964228, shared by 5 NPIs, 96 clinicians
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

11134 N State Rd
Suite 77
Hayward, WI 54843-5325
Phone (715) 634-5505

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

420 E 1St St
Duluth, MN 55805-1901
Phone (218) 786-8364

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Duluth Clinic, LTD. CurrentSince Oct 31, 2001 Accepting new patients
The Duluth Clinic, LTD CurrentSince Oct 31, 2001 Accepting new patients
Essentia Health Moose Lake CurrentSince Apr 1, 2022 Accepting new patients
Moose Lake Community Hospital District Current Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients

Locations

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

400 E 3rd St
#1S2W50
Duluth, MN 55805
Phone (218) 786-3985

4572 County Road 61
Moose Lake, MN 55767
Phone (218) 485-4481

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304035200000",
    "number": "1093779852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4687 COUNTY ROAD 13",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "557678109",
            "telephone_number": "218-485-4479",
            "fax_number": "218-786-3918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "address_2": "MAILDROP: 1S2W50",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-3985",
            "fax_number": "218-786-3018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "CONRAD",
        "middle_name": "JOSEPH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-17",
        "last_updated": "2011-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MN",
            "license": "9581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "659411500",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41921600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.