NPIMap

Individual provider Active NPI

Jeffrey B Rapp, M.D.

  • Emergency Medical Services (Emergency Medicine) Physician
  • Cloquet, MN
National Provider Identifier
1386612653
Registry record updated Nov 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
42724 Issued in MN
Practice address
Community Memorial Hospital
512 Skyline Blvd
Cloquet, MN 55720-1199
Phone
(218) 879-4641
Fax
(218) 927-4130
NPI assigned
Mar 10, 2006
Last updated
Nov 6, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 42724 MN Primary

Addresses

Primary practice location

Community Memorial Hospital
512 Skyline Blvd
Cloquet, MN 55720-1199

Mailing address

Community Memorial Hospital
512 Skyline Blvd
Cloquet, MN 55720-1199
Phone (218) 879-4641

Other identifiers 4

IdentifierTypeStateIssuer
829625100MedicaidMN
080009937OtherMNMEDICARE WPS - HOSPITAL
080011425OtherMNMEDICARE WPS - AITKIN CLI
080015004OtherMNMEDICARE WPS - MCGREGOR C

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hisdept@direct.cloquethospital.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, ND2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040805001569 MN Practitioner - Family Practice 4789655267 Reassigns benefits to 4 organizations
I20241018002485 ND Practitioner - Family Practice 4789655267 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Medical LLCGroup PAC ID 0648698290, 18 clinicians
Legacy Primary Care PLLCGroup PAC ID 5799223491, 16 clinicians

Practice addresses (Care Compare)

2100 S Columbia Rd
Suite 114
Grand Forks, ND 58201-5895
Phone (701) 516-4637

4195 Westberg Rd
Hermantown, MN 55811-2962
Phone (701) 516-4637

4195 Westberg Rd
Apt 436
Hermantown, MN 55811-3888
Phone (701) 516-4637

512 Skyline Blvd
Cloquet, MN 55720-3787
Phone (218) 879-4641

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Memorial Hospital Association CurrentSince Nov 1, 2018 Accepting new patients
Legacy Primary Care PLLC CurrentSince Oct 15, 2024 Accepting new patients
Legacy Medical LLC CurrentSince Oct 1, 2024 Accepting new patients
The Duluth Clinic, LTD. Past Accepting new patients

Locations

512 Skyline Blvd
Cloquet, MN 55720
Phone (218) 878-7207

600 S 2nd St
Ste 200
Bismarck, ND 58504
Phone (701) 757-5463

2100 S Columbia Rd
Ste 114
Grand Forks, ND 58201
Phone (701) 757-2225

Interoperability endpoints

  • Direct secure messaging: hisdept@direct.cloquethospital.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/JCIBCD

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Caringedge Hospice of Hermantown LLCHermantown, MN, CCN 241604 Hospice Contracted Managing Employee Nov 29, 2018

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604620800000",
    "number": "1386612653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "COMMUNITY MEMORIAL HOSPITAL",
            "address_2": "512 SKYLINE BLVD",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201199",
            "telephone_number": "218-879-4641",
            "fax_number": "218-927-4130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "COMMUNITY MEMORIAL HOSPITAL",
            "address_2": "512 SKYLINE BLVD",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201199",
            "telephone_number": "218-879-4641",
            "fax_number": "218-927-4130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAPP",
        "first_name": "JEFFREY",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-10",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "MN",
            "license": "42724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "829625100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE WPS - HOSPITAL",
            "identifier": "080009937",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE WPS - AITKIN CLI",
            "identifier": "080011425",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE WPS - MCGREGOR C",
            "identifier": "080015004",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hisdept@direct.cloquethospital.com",
            "affiliation": "N",
            "address_1": "Community Memorial Hospital",
            "address_2": "512 Skyline Blvd",
            "city": "Cloquet",
            "state": "MN",
            "country_code": "US",
            "postal_code": "557201199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cloquet, MN

Sources for this page

Verify at the official NPI Registry.