NPIMap

Organization Active NPI

The Duluth Clinic, LTD

Doing business as Essentia Health Hayward Pharmacy

  • Community/Retail Pharmacy
  • Hayward, WI
National Provider Identifier
1386759496
Registry record updated Feb 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
7772 Issued in WI
Legal business name
THE DULUTH CLINIC, LTD
Doing business as
Essentia Health Hayward Pharmacy
Practice address
11134 N State Road 77 Ste a
Hayward, WI 54843-5325
Phone
(715) 634-6774
Fax
(715) 634-5517
NPI assigned
Aug 20, 2006
Last updated
Feb 12, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
ST.. MARY'S DULUTH CLINIC HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 12, 2025

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

Authorized official

Name
Kevin Boren
Title
VP of Finance
Phone
(218) 786-1009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 7772 WI Primary

Addresses

Primary practice location

11134 N State Road 77 Ste a
Hayward, WI 54843-5325

Mailing address

11134 N State Road 77 Ste a
Hayward, WI 54843-5325
Phone (715) 634-6774

Other identifiers 4

IdentifierTypeStateIssuer
448819900MedicaidWI
51-24401OtherMNNCPDP
573OtherMNTHE DULUTH CLINIC, LTD CHAIN CODE
33232000MedicaidWI

Other names 1

  • Essentia Health Hayward Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20151230000109 WI Part B Supplier - Mass Immunization (Roster Biller Only) 2567374283 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hayward, WI; Superior, WI
O20230208000035 WI DME Supplier - Pharmacy 2567374283 Practice locations: Hayward, WI

Other NPIs with the same Medicare PAC ID 24

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 24

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
The Duluth Clinic LTD11134 N State Road 77, Hayward, WI 54843-5325(715) 634-6774 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Accepts assignmentParticipating since Oct 24, 2022

National Provider Directory

National Provider Directory
Tax ID family
Deer River Community CL35 organizations share this tax ID, including this one
Part of
St Mary's Duluth Clinic Health System

Other organizations with this tax ID 34

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

View all 34

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739318400000",
    "number": "1386759496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11134 N STATE ROAD 77 STE A",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548435325",
            "telephone_number": "715-634-6774",
            "fax_number": "715-634-5517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11134 N STATE ROAD 77 STE A",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548435325",
            "telephone_number": "715-634-6774",
            "fax_number": "715-634-5517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DULUTH CLINIC, LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST.. MARY'S DULUTH CLINIC HEALTH SYSTEM",
        "enumeration_date": "2006-08-20",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A",
        "authorized_official_last_name": "BOREN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "218-786-1009"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "7772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "448819900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "51-24401",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THE DULUTH CLINIC, LTD CHAIN CODE",
            "identifier": "573",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33232000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Hayward Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hayward, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.