NPIMap

Individual provider Active NPI

Kevin William Treacy, MD

  • Ophthalmology Physician
  • Duluth, MN
National Provider Identifier
1427088228
Registry record updated Dec 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
28594 Issued in MN
Practice address
324 W Superior St
800 Medical Arts
Duluth, MN 55802-1701
Phone
(218) 249-3570
Fax
(218) 722-8582
NPI assigned
Jul 4, 2006
Last updated
Dec 8, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 28594 MN Primary

Addresses

Primary practice location

324 W Superior St
800 Medical Arts
Duluth, MN 55802-1701

Mailing address

324 W Superior St
800 Medical Arts
Duluth, MN 55802-1701
Phone (218) 249-3570

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address him@slk.direct.slhduluth.com

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
I20060413000486 MN Practitioner - Ophthalmology 0648289900 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
University of Minnesota Medical School, 1983
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)

1015 E 1St St
Duluth, MN 55805-2242
Phone (218) 249-7860

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery73

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28594MNMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke's Hospital of Duluth CurrentSince Apr 2, 2013 Accepting new patients
St. Luke's Hospital of Duluth Ophthalmology CurrentSince Apr 2, 2013 Accepting new patients
St. Luke's Hospital of Duluth Current Accepting new patients
Austin & Treacy, P.a. Past Accepting new patients
St. Luke's Hospital of Duluth Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

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

324 W Superior St
Ste 800
Duluth, MN 55802
Phone (218) 249-3570

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

4190 Loberg Ave
Hermantown, MN 55811
Phone (218) 249-4600

325 11th Ave
Two Harbors, MN 55616
Phone (218) 834-5520

Interoperability endpoints

  • Direct secure messaging: ktreacy237602@direct.aspirus.org

Organizations & group practices 6

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": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607385600000",
    "number": "1427088228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 W SUPERIOR ST",
            "address_2": "800 MEDICAL ARTS",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558021701",
            "telephone_number": "218-249-3570",
            "fax_number": "218-722-8582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 W SUPERIOR ST",
            "address_2": "800 MEDICAL ARTS",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558021701",
            "telephone_number": "218-249-3570",
            "fax_number": "218-722-8582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TREACY",
        "first_name": "KEVIN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MN",
            "license": "28594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@slk.direct.slhduluth.com",
            "affiliation": "N",
            "address_1": "324 W Superior St",
            "address_2": "800 Medical Arts",
            "city": "Duluth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "558021701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.