NPIMap

Individual provider Active NPI

Thomas Joseph Witt, M.D.

  • Family Medicine Physician
  • Red Wing, MN
National Provider Identifier
1194701755
Registry record updated Nov 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30550 Issued in MN
Practice address
701 Hewitt Blvd
Red Wing, MN 55066-2848
Phone
(651) 267-5000
Fax
(651) 345-1151
NPI assigned
Dec 15, 2005
Last updated
Nov 27, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2017

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 30550 MN Primary

Addresses

Primary practice location

701 Hewitt Blvd
Red Wing, MN 55066-2848

Mailing address

701 Hewitt Blvd
Red Wing, MN 55066-2848
Phone (651) 267-5000

Other identifiers 1

IdentifierTypeStateIssuer
869582200MedicaidMN

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
I20100114000710 MN Practitioner - Family Practice 1658283189 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians
Pine Medical CenterGroup PAC ID 3870406945, 17 clinicians

Practice addresses (Care Compare)

1542 Golf Course Rd
Suite 204
Grand Rapids, MN 55744-3537
Phone (218) 999-7000

45 Lady Luck Dr
Hinckley, MN 55037-6419
Phone (320) 279-8600

705 Lundorff Dr
Sandstone, MN 55072-5099
Phone (320) 245-2211

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Deer River Healthcare Center Inc CurrentSince Jan 22, 2018 Accepting new patients
Essentia Health Moose Lake Current Accepting new patients
Deer River Healthcare Center, Inc. CurrentSince Jan 22, 2018 Accepting new patients
Deer River Healthcare Center, Inc. Current Accepting new patients
The Duluth Clinic, LTD. CurrentSince Apr 11, 2018 Accepting new patients
Essentia Health Moose Lake CurrentSince Sep 7, 2021 Accepting new patients
Pine Medical Center Current Accepting new patients
The Duluth Clinic, LTD CurrentSince Apr 11, 2018 Accepting new patients
Pine Medical Center CurrentSince Feb 19, 2024 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
Moose Lake Community Hospital District Current Accepting new patients

Locations

115 10th Ave NE
#A
Deer River, MN 56636
Phone (218) 246-8275

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

1542 Golf Course Rd
Ste 204
Grand Rapids, MN 55744
Phone (218) 322-4900

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

705 Lundorff Dr
Sandstone, MN 55072
Phone (320) 245-2211

1101 9th St N
Virginia, MN 55792
Phone (218) 305-0000

603 9th St N
Virginia, MN 55792
Phone (218) 741-3013

Organizations & group practices 11

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": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511740800000",
    "number": "1194701755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 HEWITT BLVD",
            "city": "RED WING",
            "state": "MN",
            "postal_code": "550662848",
            "telephone_number": "651-267-5000",
            "fax_number": "651-345-1151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 HEWITT BLVD",
            "city": "RED WING",
            "state": "MN",
            "postal_code": "550662848",
            "telephone_number": "651-267-5000",
            "fax_number": "651-345-1151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITT",
        "first_name": "THOMAS",
        "middle_name": "JOSEPH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2017-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "30550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "869582200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Red Wing, MN

Sources for this page

Verify at the official NPI Registry.