NPIMap

Organization Active NPI

Duluthtms, LLC

  • Psychiatry Physician
  • Duluth, MN
National Provider Identifier
1356876163
Registry record updated Apr 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
41189 Issued in MN
Legal business name
DULUTHTMS, LLC
Practice address
202 N 24TH Ave E
Duluth, MN 55812-1859
Phone
(612) 423-3238
NPI assigned
Apr 29, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2017

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

Authorized official

Name
Dr. Eric A Johnson, MDNPI 1750464640
Title
Solo Member
Phone
(612) 423-3238

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 41189 MN Primary

Addresses

Primary practice location

202 N 24TH Ave E
Duluth, MN 55812-1859

Mailing address

202 N 24TH Ave E
Duluth, MN 55812-1859
Phone (612) 423-3238

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170608000805 MN Part B Supplier - Clinic/Group Practice 0749558104 Receives reassigned benefits from 5 practitioners
Practice locations: Duluth, MN

National Provider Directory

National Provider Directory
Tax ID family
St Cloud TMS LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3333 W Division St
Ste 215
Saint Cloud, MN 56301

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1493424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493424000000",
    "number": "1356876163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 N 24TH AVE E",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558121859",
            "telephone_number": "612-423-3238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 N 24TH AVE E",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558121859",
            "telephone_number": "612-423-3238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DULUTHTMS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-29",
        "last_updated": "2017-04-29",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SOLO MEMBER",
        "authorized_official_telephone_number": "612-423-3238",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "41189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 29, 2017; 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.