Individual provider Active NPI

Jacqueline Kay Wille, MD

  • Family Medicine Physician
  • Duluth, MN
National Provider Identifier
1114776853
Registry record updated Jan 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
80900 Issued in MN
Practice address
330 N 8TH Ave E
Duluth, MN 55805-2024
Phone
(218) 723-1112
NPI assigned
May 15, 2024
Last updated
Jan 9, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 80900 MN Primary

Addresses

Primary practice location

330 N 8TH Ave E
Duluth, MN 55805-2024

Mailing address

330 N 8TH Ave E
Duluth, MN 55805-2024
Phone (218) 723-1112

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260127003053 MN Practitioner - Family Practice 7214471432 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians
Duluth Graduate Medical Education Council IncGroup PAC ID 4385545953, 32 clinicians

Practice addresses (Care Compare)

1600 Miller Trunk Hwy
BLDG C
Duluth, MN 55811-5640
Phone (218) 786-5360

330 N 8TH Ave E
Duluth, MN 55805-2024
Phone (218) 723-1112

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
80900MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Duluth Graduate Medical Education Council Inc Family Medicine CurrentSince Jan 1, 2026 Accepting new patients
The Duluth Clinic, LTD. PastSince May 19, 2024 Accepting new patients

Locations

330 N 8th Ave E
Duluth, MN 55805
Phone (218) 529-9122

Organizations & group practices 3

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 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": "1715731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767916800000",
    "number": "1114776853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 N 8TH AVE E",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052024",
            "telephone_number": "218-723-1112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 N 8TH AVE E",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052024",
            "telephone_number": "218-723-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLE",
        "first_name": "JACQUELINE",
        "middle_name": "KAY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-15",
        "last_updated": "2026-01-09",
        "certification_date": "2026-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "80900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.