Individual provider Active NPI

Edwin Etse Kwakugah, MD

  • Internal Medicine Physician
  • Grand Forks, ND
National Provider Identifier
1184033250
Registry record updated Jun 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
14567 Issued in ND
Practice address
1200 S Columbia Rd
Grand Forks, ND 58201-4036
Phone
(701) 780-5000
Fax
(701) 780-1892
NPI assigned
Aug 4, 2014
Last updated
Jun 17, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 14567 ND
Student in an Organized Health Care Education/Training Program 390200000X NY
Internal Medicine Physician 207R00000X 14567 ND Primary
Hospitalist Physician 208M00000X 14567 ND

Addresses

Primary practice location

1200 S Columbia Rd
Grand Forks, ND 58201-4036

Mailing address

2401 Demers Ave
Grand Forks, ND 58201-4183
Phone (701) 780-4085

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ekwakugah81785@direct.directaltru.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, NY, MN3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20170724000490 ND Practitioner - Internal MedicinePractitioner - Hospitalist 5597035600 Reassigns benefits to 2 organizations
I20181003003647 NY Practitioner - Internal Medicine 5597035600 Reassigns benefits to 1 organization
I20220719001313 MN Practitioner - Internal Medicine 5597035600 Reassigns benefits to 10 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mayo Clinic Health System-Southwest Minnesota RegionGroup PAC ID 4688585771, shared by 6 NPIs, 658 clinicians
North Memorial Health CareGroup PAC ID 0042123028, 502 clinicians

Practice addresses (Care Compare)

1025 Marsh St
Mankato, MN 56001-4752
Phone (507) 625-4031

3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone (763) 581-3700

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14567NDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Mayo Clinic Health System-St James CurrentSince Apr 1, 2025 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Current Accepting new patients
Mercy Hospital of Devils Lake CurrentSince Feb 3, 2018 Accepting new patients
Range Regional Health Services CurrentSince Jan 1, 2023 Accepting new patients
Mayo Clinic Health System-Fairmont CurrentSince Apr 1, 2025 Accepting new patients
Healtheast Medical Research Institute Internal Medicine CurrentSince Dec 1, 2022 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Apr 25, 2023 Accepting new patients
North Memorial Health Care Hospitalist CurrentSince Aug 1, 2022 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Current Accepting new patients
Healtheast Medical Research Insititue CurrentSince Dec 1, 2022 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Mayo Clinic Health System-St James Current Accepting new patients
Mercy Hospital of Devils Lake CurrentSince Feb 3, 2018 Accepting new patients
Range Regional Health Services Current Accepting new patients
Fairview Health Services CurrentSince Dec 1, 2022 Accepting new patients
Range Regional Health Services CurrentSince Jan 1, 2023 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Current Accepting new patients
Mercy Hospital of Devils Lake Current Accepting new patients
North Memorial Health Care CurrentSince Aug 1, 2022 Accepting new patients
North Memorial Health Care Current Accepting new patients
Cogent Medical Care PC Internal Medicine CurrentSince Jul 24, 2018 Accepting new patients

Locations

3290 Solutions Ctr
Chicago, IL 60677

800 Medical Center Dr
Fairmont, MN 56031
Phone (507) 238-8100

750 E 34th St
Hibbing, MN 55746
Phone (218) 262-3441

1025 Marsh St
Mankato, MN 56001
Phone (507) 345-2623

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

402 E Platt Ave
Nashwauk, MN 55769
Phone (218) 885-2858

301 2nd St NE
New Prague, MN 56071
Phone (952) 758-4431

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

1101 Moulton and Parsons Dr
Saint James, MN 56081
Phone (507) 375-3261

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

501 State St N
Waseca, MN 56093
Phone (507) 781-8176

1925 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 232-0100

1031 7th St NE
Devils Lake, ND 58301
Phone (701) 662-2131

565 Abbott Rd
Rm 8632
Buffalo, NY 14220
Phone (607) 798-5671

Organizations & group practices 24

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.

View all 24

Hospital & facility affiliations 5

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": "1407110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781654400000",
    "number": "1184033250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 DEMERS AVE",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014183",
            "telephone_number": "701-780-4085",
            "fax_number": "701-780-4477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S COLUMBIA RD",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014036",
            "telephone_number": "701-780-5000",
            "fax_number": "701-780-1892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWAKUGAH",
        "first_name": "EDWIN",
        "middle_name": "ETSE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-04",
        "last_updated": "2026-06-17",
        "certification_date": "2026-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "ND",
            "license": "14567",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ND",
            "license": "14567",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "ND",
            "license": "14567",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ekwakugah81785@direct.directaltru.org",
            "affiliation": "N",
            "endpointDescription": "Direct mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1200 S Columbia Rd",
            "city": "Grand Forks",
            "state": "ND",
            "country_code": "US",
            "postal_code": "582014036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.