NPIMap

Organization Active NPI

Orthopedic Associates of Duluth, P.a.

Doing business as Orthopaedic Associates of Duluth, P.A.

  • Specialist
  • Duluth, MN
National Provider Identifier
1225033715
Registry record updated Feb 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
101 Issued in MN
Legal business name
ORTHOPEDIC ASSOCIATES OF DULUTH, P.A.
Doing business as
Orthopaedic Associates of Duluth, P.A.
Practice address
1000 E 1St St
Ste 404
Duluth, MN 55805-2297
Phone
(218) 722-9753
Fax
(218) 722-6515
NPI assigned
Jun 20, 2005
Last updated
Feb 23, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2016

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

Authorized official

Name
June Waller
Title
Office Manager
Phone
(218) 625-1886

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 101 MN Primary

Addresses

Primary practice location

1000 E 1St St
Ste 404
Duluth, MN 55805-2297

Mailing address

1000 E 1St St
Ste 404
Duluth, MN 55805-2297
Phone (218) 722-9753

Other identifiers 4

IdentifierTypeStateIssuer
177808100MedicaidMN
78040OROtherMNBLUE CROSS
000018080OtherWIMEDICARE WPS
A001OtherTRICARE

Other names 1

  • Orthopaedic Associates of Duluth, P.A. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040203001028 WI Part B Supplier - Clinic/Group Practice 1951294065 Receives reassigned benefits from 5 practitioners
Practice locations: Grantsburg, WI; Hayward, WI
O20100930037833 MN DME Supplier - Physician - Orthopedic/Orthopedic Surgery 1951294065 Practice locations: Duluth, MN
O20140617000407 MN Part B Supplier - Clinic/Group Practice 1951294065 Receives reassigned benefits from 47 practitioners
Practice locations: Duluth, MN; Grand Rapids, MN; Virginia, MN

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1000 E 1st St
#4
Duluth, MN 55805
Phone (218) 722-5513

1000 E 1st St
Ste 400
Duluth, MN 55805
Phone (218) 625-2728

1000 E 1st St
Ste 404
Duluth, MN 55805
Phone (218) 722-5513

1601 Golf Course Rd
Grand Rapids, MN 55744
Phone (218) 326-3401

4310 Menard Dr
Ste 400
Hermantown, MN 55811
Phone (218) 625-2727

3429 E Beltline
Hibbing, MN 55746
Phone (218) 263-3880

109 N 28th St E
Superior, WI 54880
Phone (715) 395-3900

Practitioners & affiliated clinicians

Practitioners 57

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 57

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456185600000",
    "number": "1225033715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E 1ST ST",
            "address_2": "STE 404",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052297",
            "telephone_number": "218-722-9753",
            "fax_number": "218-722-6515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E 1ST ST",
            "address_2": "STE 404",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052297",
            "telephone_number": "218-722-9753",
            "fax_number": "218-722-6515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC ASSOCIATES OF DULUTH, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-20",
        "last_updated": "2016-02-23",
        "status": "A",
        "authorized_official_last_name": "WALLER",
        "authorized_official_first_name": "JUNE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "218-625-1886"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MN",
            "license": "101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "177808100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "78040OR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE WPS",
            "identifier": "000018080",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "A001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orthopaedic Associates of Duluth, P.A.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Duluth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.