NPIMap

Individual provider Active NPI

Marissa Lee Wraalstad-Tomann

  • Student in an Organized Health Care Education/Training Program
  • Des Moines, IA
National Provider Identifier
1487281036
Registry record updated Mar 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
3200 Grand Ave
Des Moines, IA 50312-4104
Phone
(515) 271-1569
NPI assigned
Mar 24, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

3200 Grand Ave
Des Moines, IA 50312-4104

Mailing address

2396 132ND LN NW
Coon Rapids, MN 55448-2570
Phone (763) 370-7404

Other names 1

  • Marissa Lee Wraalstad Former name

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
I20201210002897 MN Practitioner - Physician Assistant 6901218262 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians

Practice addresses (Care Compare)

1502 London Rd
Suite 102
Duluth, MN 55812-1787
Phone (218) 727-8228

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

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Duluth Clinic, LTD. CurrentSince Nov 25, 2020 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
The Duluth Clinic, LTD CurrentSince Nov 25, 2020 Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients

Locations

1502 London Rd
Ste 102
Duluth, MN 55812
Phone (218) 576-0100

4212 Grand Ave
Duluth, MN 55807
Phone (218) 786-3500

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

4855 W Arrowhead Rd
Hermantown, MN 55811
Phone (218) 786-3540

211 S Boundary Ave
Proctor, MN 55810
Phone (218) 624-4818

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

Organizations & group practices 7

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 4

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": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585008000000",
    "number": "1487281036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2396 132ND LN NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554482570",
            "telephone_number": "763-370-7404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 GRAND AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503124104",
            "telephone_number": "515-271-1569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WRAALSTAD-TOMANN",
        "first_name": "MARISSA",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-24",
        "last_updated": "2020-03-24",
        "certification_date": "2020-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISSA",
            "last_name": "WRAALSTAD",
            "middle_name": "LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.