Individual provider Active NPI

John Paul Tennis, PA-C

  • Physician Assistant
  • Duluth, MN
National Provider Identifier
1376667063
Registry record updated Jan 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
14525 Issued in MN
Practice address
400 E 3Rd St
Duluth, MN 55805-1951
Phone
(218) 786-4000
NPI assigned
Mar 19, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1117331 CA
Physician Assistant 363A00000X 7809 WI
Physician Assistant 363A00000X 14525 MN Primary

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

34800 Bob Wilson Dr
San Diego, CA 92134-1098
Phone (760) 339-2674

Other practice location 2

3500 Tower Ave
Superior, WI 54880-4491
Phone (715) 817-7100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, MN, WI3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20221004001983 CA Practitioner - Physician Assistant 2567848278 Reassigns benefits to 1 organization
I20240425002857 MN Practitioner - Physician Assistant 2567848278 Reassigns benefits to 4 organizations
I20240531002526 WI Practitioner - Physician Assistant 2567848278 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Nebraska College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians

Practice addresses (Care Compare)

1413 Hwy 33 S
Cloquet, MN 55720-2626
Phone (218) 337-4000

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

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

4212 Grand Ave
Duluth, MN 55807-2737
Phone (218) 786-3500

4855 W Arrowhead Rd
Hermantown, MN 55811-3936
Phone (218) 786-3540

603 9TH St N
Virginia, MN 55792-2319
Phone (218) 741-3013

901 9TH St N
Virginia, MN 55792-2398
Phone (218) 748-7750

Hospital & facility affiliations

  • Essentia Health Duluth Hospital, Duluth, MN, CCN 240019
  • St Marys Hospital Superior Hospital, Superior, WI, CCN 521329
  • Essentia Health St Mary'S Medical Center Hospital, Duluth, MN, CCN 240002

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1117331CAMDPhysician Assistant
14525MNMDPhysician Assistant
7809WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Medical Center CurrentSince Mar 25, 2024 Accepting new patients
Anaheim Urgent Care, Inc. CurrentSince Jun 8, 2022 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
The Duluth Clinic LTD CurrentSince Mar 25, 2024 Accepting new patients
Moose Lake Community Hospital District Current Accepting new patients
Essentia Health Moose Lake CurrentSince Mar 25, 2024 Accepting new patients
Essentia Health Moose Lake CurrentSince Mar 25, 2024 Accepting new patients
St. Mary'S Hospital of Superior CurrentSince May 27, 2024 Accepting new patients
St. Mary'S Hospital of Superior CurrentSince Jul 1, 2025 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Mar 25, 2024 Accepting new patients
Anaheim Urgent Care, Inc. Current Accepting new patients

Locations

831 S State College Blvd
Anaheim, CA 92806
Phone (714) 533-2273

6010 Hidden Valley Rd
Ste 150
Carlsbad, CA 92011
Phone (760) 544-8233

1300 N La Brea Ave
Los Angeles, CA 90028
Phone (323) 464-1336

5717 Melrose Ave
Los Angeles, CA 90038
Phone (323) 957-2273

888 S Figueroa St
Ste 600
Los Angeles, CA 90017

35 W Los Angeles Ave
Moorpark, CA 93021
Phone (805) 529-5370

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

4212 Grand Ave
Duluth, MN 55807
Phone (218) 786-3500

400 E 3rd St
#6
Duluth, MN 55805
Phone (320) 360-1676

4855 W Arrowhead Rd
Hermantown, MN 55811
Phone (218) 786-3540

4572 County Road 61
Moose Lake, MN 55767
Phone (218) 485-4481

705 Lundorff Dr
Sandstone, MN 55072
Phone (320) 245-2211

603 9th St N
Virginia, MN 55792
Phone (218) 741-3013

3500 Tower Ave
Superior, WI 54880
Phone (715) 392-8281

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736208000000",
    "number": "1376667063",
    "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": "218-786-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "34800 Bob Wilson Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921341098",
            "country_code": "US",
            "telephone_number": "760-339-2674",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3500 Tower Ave",
            "address_purpose": "LOCATION",
            "city": "Superior",
            "state": "WI",
            "postal_code": "548804491",
            "country_code": "US",
            "telephone_number": "715-817-7100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TENNIS",
        "first_name": "JOHN",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "1117331",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "7809",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.