NPIMap

Individual provider Active NPI

Jeri Leah Vergeldt

  • Family Medicine Physician
  • International Falls, MN
National Provider Identifier
1215961560
Registry record updated May 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35532 Issued in MN
Practice address
2501 Keenan Dr
International Falls, MN 56649-2181
Phone
(218) 283-9431
Fax
(218) 285-6275
NPI assigned
Jul 11, 2006
Last updated
May 9, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2011

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 35532 MN Primary

Addresses

Primary practice location

2501 Keenan Dr
International Falls, MN 56649-2181

Mailing address

2501 Keenan Dr
International Falls, MN 56649-2181
Phone (218) 283-9431

Other identifiers 2

IdentifierTypeStateIssuer
943365100MedicaidMN
32404700MedicaidWI

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
I20090806000407 MN Practitioner - Family Practice 3375696412 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Essentia Health Virginia LLCGroup PAC ID 7810149002, 64 clinicians

Practice addresses (Care Compare)

2501 Keenan Dr
International Falls, MN 56649-2181
Phone (218) 283-9431

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35532MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Essentia Health Virginia, LLC CurrentSince Dec 1, 2016 Accepting new patients
The Duluth Clinic, LTD. CurrentSince May 18, 2015 Accepting new patients
The Duluth Clinic, LTD CurrentSince May 18, 2015 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
Essentia Health Virginia, LLC CurrentSince Dec 1, 2016 Accepting new patients
Essentia Health Virginia, LLC Past Accepting new patients
The Evangelical Lutheran Good Samaritan Society Past Accepting new patients

Locations

600 Main Ave S
Birchdale, MN 56623
Phone (218) 634-1655

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

1400 Highway 71
Intl Falls, MN 56649
Phone (218) 283-4481

2501 Keenan Dr
Intl Falls, MN 56649
Phone (218) 283-4481

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

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

901 9th St N
Virginia, MN 55792
Phone (218) 741-3340

Organizations & group practices 7

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 3

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": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304899200000",
    "number": "1215961560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 KEENAN DR",
            "city": "INTERNATIONAL FALLS",
            "state": "MN",
            "postal_code": "566492181",
            "telephone_number": "218-283-9431",
            "fax_number": "218-285-6275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 KEENAN DR",
            "city": "INTERNATIONAL FALLS",
            "state": "MN",
            "postal_code": "566492181",
            "telephone_number": "218-283-9431",
            "fax_number": "218-285-6275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERGELDT",
        "first_name": "JERI",
        "middle_name": "LEAH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2011-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "35532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "943365100",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32404700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in International Falls, MN

Sources for this page

Verify at the official NPI Registry.