NPIMap

Organization Active NPI

The Duluth Clinic, LTD

Doing business as Essentia Health Duluth Clinic

  • Multi-Specialty Clinic/Center
  • Duluth, MN
National Provider Identifier
1245278209
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
THE DULUTH CLINIC, LTD
Doing business as
Essentia Health Duluth Clinic
Practice address
400 E 3Rd St
Duluth, MN 55805-1951
Phone
(218) 786-8364
NPI assigned
Jun 3, 2006
Last updated
Apr 17, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

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

Authorized official

Name
Kevin Boren
Title
VP of Finance
Phone
(218) 786-1009

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Multi-Specialty Clinic/Center 261QM1300X Primary
Durable Medical Equipment & Medical Supplies 332B00000X
Optometrist 152W00000X
Community/Retail Pharmacy 3336C0003X 261245 MN

Addresses

Primary practice location

400 E 3Rd St
Duluth, MN 55805-1951

Mailing address

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

Other practice location 1

420 E 1st St
Duluth, MN 55805-1901
Phone (218) 786-8364

Other practice location 2

502 E 2nd St
Duluth, MN 55805-1913
Phone (218) 786-8364

Other practice location 3

530 E 2nd St
Duluth, MN 55805-1913
Phone (218) 786-8364

Other identifiers 1

IdentifierTypeStateIssuer
1245278209MedicaidMN

Other names 1

  • Essentia Health Duluth Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN, CA, SD, TX, FL, KS, UT, ND, MO, WV, NC, WA, AZ, IN, IL18 enrollments

Enrollment records 18

Enrollment IDStateProvider typePAC IDDetails
O20031103000120 WI Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 185 practitioners
7 other NPIs on this enrollment
Practice locations: Ashland, WI; Hayward, WI; Mellen, WI; Mequon, WI; Superior, WI
O20031103000229 MN Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 1,610 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20100930013927 MN DME Supplier - Multi-Specialty - Physician 2567374283 Practice locations: Duluth, MN
O20181205000866 WI Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 2 practitioners
Practice locations: Hayward, WI; Sheboygan, WI; South Range, WI; Superior, WI
O20211112001611 CA Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 5 practitioners
Practice locations: Bakersfield, CA; Cerritos, CA; La Crescenta, CA
O20221102002783 SD Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 1 practitioner
Practice locations: Sioux Falls, SD
O20221108002763 TX Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 1 practitioner
Practice locations: Frisco, TX
O20221206003393 FL Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 4 practitioners
Practice locations: Longboat Key, FL; Sarasota, FL; Palm Harbor, FL; Bonita Springs, FL
O20221229002595 KS Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 1 practitioner
Practice locations: Prairie Village, KS
O20230201002352 UT Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 1 practitioner
Practice locations: Draper, UT
O20230202001506 ND Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 1 practitioner
Practice locations: Bismarck, ND
O20230203001116 MO Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 1 practitioner
Practice locations: Saint Louis, MO
O20230206000854 WV Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 1 practitioner
Practice locations: Falling Waters, WV
O20230207000950 NC Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 2 practitioners
Practice locations: Concord, NC; Cornelius, NC
O20230208000150 WA Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 2 practitioners
Practice locations: Seattle, WA
O20230327000412 AZ Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 2 practitioners
Practice locations: Phoenix, AZ; Sedona, AZ
O20230506000259 IN Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 1 practitioner
Practice locations: Indianapolis, IN; Noblesville, IN
O20230508001988 IL Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 1 practitioner
Practice locations: Washington, IL

Other NPIs with the same Medicare PAC ID 24

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 24

Other NPIs on the same Medicare enrollment 28

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 28

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3838 San Dimas St
Ste A140
Bakersfield, CA 93301
Phone (661) 327-4647

1600 Miller Trunk Hwy
#1300
Duluth, MN 55811

400 E 3rd St
#2
Duluth, MN 55805
Phone (218) 786-8319

Practitioners & affiliated clinicians

Practitioners 715

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 715

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1245278209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 E 1st St",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558051901",
            "country_code": "US",
            "telephone_number": "218-786-8364",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "502 E 2nd St",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558051913",
            "country_code": "US",
            "telephone_number": "218-786-8364",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "530 E 2nd St",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558051913",
            "country_code": "US",
            "telephone_number": "218-786-8364",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE DULUTH CLINIC, LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2006-06-03",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "BOREN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "218-786-1009"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "261245",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245278209",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Duluth Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Duluth Clinic",
            "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 Apr 17, 2024; 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.