Bradford Marvin Wilson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

407 E 3Rd St
Duluth, MN 55805-1950

Phone

(218) 786-8364

NPI assigned

Apr 24, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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 1

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Essentia Health St Mary's Medical Center Hospital, Duluth, MN, CCN 240002
• Essentia Health Duluth Hospital, Duluth, MN, CCN 240019
• Essentia Health Virginia Hospital, Virginia, MN, CCN 240084

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• The Duluth Clinic LTD

  dba Essentia Health Cloquet Clinic

  • Multi-Specialty Clinic/Center
  • Cloquet, MN
  • NPI 1902563638
  Medicare reassignment Care Compare group NPD
• Pine Medical Center

  dba Essentia Health Sandstone

  • Critical Access Hospital
  • Sandstone, MN
  • NPI 1326041633
  Medicare reassignment NPD
• Pine Medical Center

  dba Essentia Health Hinckley Clinic

  • Multi-Specialty Clinic/Center
  • Hinckley, MN
  • NPI 1720859531
  NPD
• The Duluth Clinic, LTD.

  dba Essentia Health Hinckley Pharmacy

  • Community/Retail Pharmacy
  • Hinckley, MN
  • NPI 1245081066
  NPD
• The Duluth Clinic, LTD

  dba Duluth Clinic

  • Anesthesiology Physician
  • Duluth, MN
  • NPI 1760417935
  NPD (past)

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

• Essentia Health Virginia, LLC

  dba Essentia Health Virginia

  • General Acute Care Hospital
  • Virginia, MN
  • NPI 1083617120
  Care Compare affiliation
• St Marys Medical Center

  dba Essentia Health St Marys Medical Center

  • General Acute Care Hospital
  • Duluth, MN
  • NPI 1457393035
  Care Compare affiliation
• St. Marys Medical Center

  dba SMMC Life Flight

  • Air Ambulance
  • Duluth, MN
  • NPI 1841359478

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1524528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524528000000",
    "number": "1396233557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1340 WALNUT ST",
            "city": "WESTERN SPRINGS",
            "state": "IL",
            "postal_code": "605581359",
            "telephone_number": "708-927-5945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051950",
            "telephone_number": "218-786-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "BRADFORD",
        "middle_name": "MARVIN",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-24",
        "last_updated": "2018-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Marie Williams
• Robin A Williams, PH.D.,LCSW,
• Sarah Adrianne Williams, LMFT
• Liza Williamson
• Eric Lee Willms, PSY.D., LP
• Erik Wilson
• Julie Wilson
• Tara Y Wimmer, NP
• Andrea Dawn Winans
• Rebecca J Winans, CRNA

• Physician Assistant in Duluth, MN
• Providers in Duluth, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.