Individual provider Active NPI

Benjamin Douglas Hustedt, LICSW

  • Clinical Social Worker
  • Duluth, MN
National Provider Identifier
1114511714
Registry record updated Feb 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
27270 Issued in MN
Practice address
615 Pecan Ave
Duluth, MN 55811-2749
Phone
(218) 355-2100
NPI assigned
Feb 24, 2021
Last updated
Feb 24, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 27270 MN Primary

Addresses

Primary practice location

615 Pecan Ave
Duluth, MN 55811-2749

Mailing address

SSB-5
400 East Third Street
Duluth, MN 55805
Phone (218) 786-8364

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220617002146 MN Practitioner - Clinical Social Worker 6305225517 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
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)

530 E 2ND St
Duluth, MN 55805-1913
Phone (218) 786-8364

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
27270MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
SMDC Medical Center CurrentSince Mar 4, 2021 Accepting new patients
The Duluth Clinic, LTD. CurrentSince May 23, 2022 Accepting new patients
The Duluth Clinic, LTD CurrentSince May 23, 2022 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
SMDC Medical Center PastSince Mar 4, 2021 Accepting new patients

Locations

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

530 E 2nd St
Duluth, MN 55805
Phone (218) 786-5300

615 Pecan Ave
Duluth, MN 55811
Phone (218) 355-2100

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1614124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614124800000",
    "number": "1114511714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "SSB-5",
            "address_2": "400 EAST THIRD STREET",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "55805",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 PECAN AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558112749",
            "telephone_number": "218-355-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUSTEDT",
        "first_name": "BENJAMIN",
        "middle_name": "DOUGLAS",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-24",
        "last_updated": "2021-02-24",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "27270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.