NPIMap

Individual provider Active NPI

Kenneth Dornfeld, MD

  • Radiation Oncology Physician
  • Duluth, MN
National Provider Identifier
1174524300
Registry record updated May 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
49970 Issued in MN
Practice address
400 East 3Rd Street
Duluth, MN 55805
Phone
(218) 786-8364
NPI assigned
Aug 10, 2005
Last updated
May 19, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 34808 IA
Radiation Oncology Physician 2085R0001X 49970 MN Primary

Addresses

Primary practice location

400 East 3Rd Street
Duluth, MN 55805

Mailing address

400 East 3Rd Street
Duluth, MN 55805
Phone (218) 786-8364

Other identifiers 1

IdentifierTypeStateIssuer
679487000MedicaidMN

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080104000352 MN Practitioner - Radiation Oncology 8729171707 Reassigns benefits to 1 organization
I20160602001391 WI Practitioner - Radiation Oncology 8729171707 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
University of Minnesota Medical School, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

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

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

402 E 2ND St
Duluth, MN 55805-1906
Phone (218) 786-4000

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

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

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
34808IAMDRadiation Oncology Physician
49970MNMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Duluth Clinic LTD Current Accepting new patients
The Duluth Clinic, LTD CurrentSince Aug 27, 2007 Accepting new patients
Memorial Medical Center Inc CurrentSince May 3, 2016 Accepting new patients
Memorial Medical Center Inc CurrentSince May 3, 2016 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Aug 27, 2007 Accepting new patients
Medical Services, Inc Past Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients

Locations

420 E 1st St
Duluth, MN 55805
Phone (218) 786-1265

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

1615 Maple Ln
Ashland, WI 54806
Phone (715) 682-4563

Organizations & group practices 8

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 7

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": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305763200000",
    "number": "1174524300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 EAST 3RD 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": "400 EAST 3RD STREET",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "55805",
            "telephone_number": "218-786-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORNFELD",
        "first_name": "KENNETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2011-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "IA",
            "license": "34808",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "MN",
            "license": "49970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "679487000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.