NPIMap

Individual provider Active NPI

Thomas Jon Rishavy, MD

  • Plastic Surgery Physician
  • Duluth, MN
National Provider Identifier
1295771798
Registry record updated Apr 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
45103 Issued in MN
Practice address
4316 Rice Lake Rd Ste 109
Duluth, MN 55811-2885
Phone
(218) 724-7363
Fax
(218) 724-6199
NPI assigned
Jun 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 45103 MN Primary

Addresses

Primary practice location

4316 Rice Lake Rd Ste 109
Duluth, MN 55811-2885

Mailing address

4316 Rice Lake Rd Ste 109
Duluth, MN 55811-2885
Phone (218) 724-7363

Other identifiers 1

IdentifierTypeStateIssuer
078738800MedicaidMN

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
I20040603000938 MN Practitioner - Plastic and Reconstructive Surgery 2769464700 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Creighton University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians
Northland Plastic Surgery PAGroup PAC ID 3577545870, 3 clinicians

Practice addresses (Care Compare)

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

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

4316 Rice Lake Rd
Suite 109
Duluth, MN 55811-2885
Phone (218) 724-7363

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

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

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
45103MNMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northland Plastic Surgery, PA Plastic Surgery CurrentSince Aug 1, 2004 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
The Duluth Clinic, LTD. CurrentSince Nov 3, 2014 Accepting new patients
The Duluth Clinic LTD CurrentSince Nov 3, 2014 Accepting new patients
Advanced Surgical Associates of Northern Minnesota PLLC Plastic Surgery Past Accepting new patients

Locations

4316 Rice Lake Rd
Ste 109
Duluth, MN 55811
Phone (218) 724-7363

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

1420 London Rd
Ste 101
Duluth, MN 55805
Phone (218) 461-2122

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22569/brand/1/csg/1/fhir/r4
  • FHIR API: https://api.platform.athenahealth.com/23029/brand/1/csg/1/fhir/r4
  • Direct secure messaging: thomas.rishavy.1@23029.direct.athenahealth.com

Organizations & group practices 6

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 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775520000000",
    "number": "1295771798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4316 RICE LAKE RD STE 109",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558112885",
            "telephone_number": "218-724-7363",
            "fax_number": "218-724-6199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4316 RICE LAKE RD STE 109",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558112885",
            "telephone_number": "218-724-7363",
            "fax_number": "218-724-6199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RISHAVY",
        "first_name": "THOMAS",
        "middle_name": "JON",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2026-04-07",
        "certification_date": "2026-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "MN",
            "license": "45103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "078738800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.