NPIMap

Individual provider Active NPI

Danijela Mataic, MD

  • Nephrology Physician
  • Duluth, MN
National Provider Identifier
1407895840
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
75244 Issued in MN
Practice address
915 E 1St St
Duluth, MN 55805-2107
Phone
(218) 249-5439
Fax
(218) 249-5624
NPI assigned
Jun 4, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 2004003811 MO
Nephrology Physician 207RN0300X 75244 MN Primary

Addresses

Primary practice location

915 E 1St St
Duluth, MN 55805-2107

Mailing address

7320 Forsyth Blvd Apt 104
Saint Louis, MO 63105-2168
Phone (314) 269-7672

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20231120002930 MN Practitioner - Nephrology 0143285007 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Luke's Hospital of DuluthGroup PAC ID 7113834839, 409 clinicians

Practice addresses (Care Compare)

1001 E Superior St
Suite 201
Duluth, MN 55802-2228
Phone (218) 279-6230

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
75244MNMDNephrology Physician
2004003811MOMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke's Hospital of Duluth Current Accepting new patients
St. Luke's Hospital of Duluth CurrentSince Oct 1, 2023 Accepting new patients
St. Luke's Hospital of Duluth CurrentSince Oct 1, 2023 Accepting new patients
Nephrology and Hypertension Specialists, LLC Nephrology PastSince Jan 28, 2024 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

915 E 1st St
Duluth, MN 55805
Phone (218) 249-5352

1001 E Superior St
Ste 201
Duluth, MN 55802
Phone (218) 249-3057

1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: danijela.mataic.p1@direct.nephrologyhtn.nextgenshare.com

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 and National Provider Directory roles.

Hospital & facility affiliations 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1407895840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7320 FORSYTH BLVD APT 104",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631052168",
            "telephone_number": "314-269-7672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 E 1ST ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052107",
            "telephone_number": "218-249-5439",
            "fax_number": "218-249-5624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATAIC",
        "first_name": "DANIJELA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-04",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MO",
            "license": "2004003811",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MN",
            "license": "75244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.