Sally Lynn Bruestle, PA
Individual provider Active NPI Physician Assistant · Silver Bay, MN
NPI 1295255693 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1295255693
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 50 Outer Dr
Silver Bay, MN 55614-1102 - Phone
- (218) 226-4431
- Fax
- (218) 226-4425
- NPI assigned
- Jun 27, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 14
Hospital & facility affiliations 40
Medicare Care Compare profile
- 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 Duluth
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
- Aspirus St. Luke'S at Home - Home Care - Duluth
- Aspirus Lake View Hospital
- St Lukes Hospital
- Aspirus Wausau Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171129003035 | MN | Practitioner - Physician Assistant | 9537426549 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12547 | MN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake View Memorial Hospital, Inc. | Current |
Accepting new patients | |
| St. Luke'S Hospital of Duluth | Current |
Accepting new patients | |
| St. Luke'S Hospital of Duluth | Current |
Accepting new patients | |
| St. Luke'S Hospital of Duluth | Past | Accepting new patients |
Locations
29980 Network Pl
Chicago, IL 60673
1400 Woodland Ave
Duluth, MN 55803
Phone (218) 249-8800
1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860
915 E 1st St
Duluth, MN 55805
Phone (218) 249-5352
619 W Central Entrance
Duluth, MN 55811
Phone (218) 249-4987
50 Outer Dr
Silver Bay, MN 55614
Phone (218) 226-4431
325 11th Ave
Two Harbors, MN 55616
Phone (218) 834-5520
Interoperability endpoints
- sbruestle237288@direct.aspirus.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
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
- Sally Lynn Spitzer
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | him@lkv.direct.slhduluth.com |
Other providers in Silver Bay, MN
- Julie Ann Boll
- Andrew J Buell
- Kaylee Cahill Mathews
- Paulina Chalupsky
- Thomas Matthew Clifford
- Julee M Dehart
All providers in Silver Bay, MN · Physician Assistant in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.