NPIMap

Individual provider Active NPI

Theresa Elizabeth Weerts, MD

  • Family Medicine Physician
  • Superior, WI
National Provider Identifier
1386870624
Registry record updated Aug 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
57211 Issued in WI
Practice address
3500 Tower Ave
Essentia Health St. Mary's Superior Clinic
Superior, WI 54880-5335
Phone
(715) 817-7100
NPI assigned
Jun 1, 2009
Last updated
Aug 8, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 125056148 IL
Family Medicine Physician 207Q00000X 57211 WI Primary

Addresses

Primary practice location

3500 Tower Ave
Essentia Health St. Mary's Superior Clinic
Superior, WI 54880-5335

Mailing address

3500 Tower Ave
Essentia Health St. Mary's Superior Clinic
Superior, WI 54880-5335
Phone (715) 817-7100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20120723000388 WI Practitioner - Emergency MedicinePractitioner - Family Practice 2163688011 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Loyola University of Chicago, Stritch School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians
St Marys Hospital of SuperiorGroup PAC ID 8628964228, 96 clinicians

Practice addresses (Care Compare)

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

3500 Tower Ave
Superior, WI 54880-4491
Phone (715) 392-8281

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125056148ILMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary's Hospital of Superior CurrentSince Mar 1, 2020 Accepting new patients
St. Mary's Duluth Clinic Health System Current Accepting new patients
St. Mary's Hospital of Superior CurrentSince Mar 1, 2020 Accepting new patients

Locations

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

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 6

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": "1243814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344384000000",
    "number": "1386870624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 TOWER AVE",
            "address_2": "ESSENTIA HEALTH ST. MARY'S SUPERIOR CLINIC",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548805335",
            "telephone_number": "715-817-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 TOWER AVE",
            "address_2": "ESSENTIA HEALTH ST. MARY'S SUPERIOR CLINIC",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548805335",
            "telephone_number": "715-817-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEERTS",
        "first_name": "THERESA",
        "middle_name": "ELIZABETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-01",
        "last_updated": "2012-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125056148",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "57211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Superior, WI

Sources for this page

Verify at the official NPI Registry.