NPIMap

Individual provider Active NPI

Addie Christine Vittorio, M.D.

  • Family Medicine Physician
  • Duluth, MN
National Provider Identifier
1225205149
Registry record updated Dec 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
51985 Issued in MN
Practice address
1400 Woodland Ave
Duluth, MN 55803-2624
Phone
(218) 249-8800
Fax
(218) 249-8828
NPI assigned
May 9, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

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 51985 MN Primary

Addresses

Primary practice location

1400 Woodland Ave
Duluth, MN 55803-2624

Mailing address

1400 Woodland Ave
Duluth, MN 55803-2624
Phone (218) 249-8800

Other identifiers 5

IdentifierTypeStateIssuer
1225205149OtherWIGROUP HEALTH
1225205149MedicaidMN
P00767175OtherMEDICARE RAILROAD
01-37337OtherMEDICA
1225205149OtherMNBCBS MN

Other names 1

  • Addie Christine Licari Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address him@slk.direct.slhduluth.com

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
I20091001000162 MN Practitioner - Family Practice 2466485875 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

  • St Lukes Hospital Hospital, Duluth, MN, CCN 240047

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2342MNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke'S Hospital of Duluth Current Accepting new patients
St. Luke'S Hospital of Duluth CurrentSince Sep 1, 2011 Accepting new patients
St. Luke'S Hospital of Duluth CurrentSince Sep 1, 2011 Accepting new patients
Lake View Memorial Hospital, Inc CurrentSince May 19, 2020 Accepting new patients
Lake View Memorial Hospital, Inc. CurrentSince May 19, 2020 Accepting new patients
Hennepin County Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

512 Skyline Blvd
Cloquet, MN 55720
Phone (218) 878-7207

1400 Woodland Ave
Duluth, MN 55803
Phone (218) 249-8800

915 E 1st St
Duluth, MN 55805
Phone (218) 249-5352

1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860

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

325 11th Ave
Two Harbors, MN 55616
Phone (218) 834-5520

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 and National Provider Directory roles.

Hospital & facility affiliations 26

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1210291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1225205149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 WOODLAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558032624",
            "telephone_number": "218-249-8800",
            "fax_number": "218-249-8828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 WOODLAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558032624",
            "telephone_number": "218-249-8800",
            "fax_number": "218-249-8828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITTORIO",
        "first_name": "ADDIE",
        "middle_name": "CHRISTINE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-09",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "51985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH",
            "identifier": "1225205149",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225205149",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00767175",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "01-37337",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MN",
            "identifier": "1225205149",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@slk.direct.slhduluth.com",
            "affiliation": "N",
            "address_1": "1400 Woodland Ave",
            "city": "Duluth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "558032624",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ADDIE",
            "last_name": "LICARI",
            "middle_name": "CHRISTINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.