NPIMap

Individual provider Active NPI

Sally Lynn Bruestle, PA

  • Physician Assistant
  • Silver Bay, MN
National Provider Identifier
1295255693
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
50 Outer Dr
Silver Bay, MN 55614-1102
Phone
(218) 226-4431
Fax
(218) 226-4425
NPI assigned
Jun 27, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

50 Outer Dr
Silver Bay, MN 55614-1102

Mailing address

50 Outer Dr
Silver Bay, MN 55614-1102
Phone (218) 226-4431

Other names 1

  • Sally Lynn Spitzer Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address him@lkv.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
I20171129003035 MN Practitioner - Physician Assistant 9537426549 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Sanford School of Medicine of University of South Dakota, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Luke's Hospital of DuluthGroup PAC ID 7113834839, 409 clinicians

Practice addresses (Care Compare)

1011 E 1St St
Duluth, MN 55805-2242
Phone (218) 249-7000

1015 E 1St St
Duluth, MN 55805-2242
Phone (218) 249-7860

1120 E 34TH St
Hibbing, MN 55746-2909
Phone (218) 362-7100

50 Outer Dr
Silver Bay, MN 55614-1102
Phone (218) 226-4431

8373 Unity Dr
Virginia, MN 55792-4005
Phone (218) 748-7480

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke's Hospital of Duluth CurrentSince Oct 9, 2017 Accepting new patients
Lake View Memorial Hospital, Inc. CurrentSince May 25, 2020 Accepting new patients
St. Luke's Hospital of Duluth Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

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

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

619 W Central Entrance
Duluth, MN 55811
Phone (218) 249-4987

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

50 Outer Dr
Silver Bay, MN 55614
Phone (218) 226-4425

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

Interoperability endpoints

  • Direct secure messaging: sbruestle237288@direct.aspirus.org

Organizations & group practices 5

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 40

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

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1498521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1295255693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 OUTER DR",
            "city": "SILVER BAY",
            "state": "MN",
            "postal_code": "556141102",
            "telephone_number": "218-226-4431",
            "fax_number": "218-226-4425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 OUTER DR",
            "city": "SILVER BAY",
            "state": "MN",
            "postal_code": "556141102",
            "telephone_number": "218-226-4431",
            "fax_number": "218-226-4425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUESTLE",
        "first_name": "SALLY",
        "middle_name": "LYNN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-27",
        "last_updated": "2022-07-21",
        "certification_date": "2020-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@lkv.direct.slhduluth.com",
            "affiliation": "N",
            "address_1": "50 Outer Dr",
            "city": "Silver Bay",
            "state": "MN",
            "country_code": "US",
            "postal_code": "556141102",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SALLY",
            "last_name": "SPITZER",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Silver Bay, MN

Sources for this page

Verify at the official NPI Registry.