NPIMap

Organization Active NPI

Univeristy of Minnesota Duluth

Doing business as UMD Sports Medicine

  • Sports Medicine (Family Medicine) Physician
  • Duluth, MN
National Provider Identifier
1497157168
Registry record updated Sep 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
Legal business name
UNIVERISTY OF MINNESOTA DULUTH
Doing business as
UMD Sports Medicine
Practice address
1216 Ordean CT
Duluth, MN 55812-3032
Phone
(218) 726-8709
NPI assigned
Sep 24, 2014
Last updated
Sep 24, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2014

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

Authorized official

Name
Josh Berlo
Title
Asst Ath Dir for Sports Medicine
Phone
(218) 726-8637

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207QS0010X Primary

Addresses

Primary practice location

1216 Ordean CT
Duluth, MN 55812-3032

Mailing address

5050 Spring Valley Rd
Dallas, TX 75244-3995
Phone (800) 555-9073

Other names 1

  • UMD Sports Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Comm-Univ HLTH Care Psy33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

Organizations that report the same tax identification number in the National Provider Directory.

View all 32

Locations

1216 Ordean Ct
Duluth, MN 55812
Phone (218) 726-8415

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1411516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411516800000",
    "number": "1497157168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 SPRING VALLEY RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752443995",
            "telephone_number": "800-555-9073",
            "fax_number": "972-367-3452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 ORDEAN CT",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558123032",
            "telephone_number": "218-726-8709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERISTY OF MINNESOTA DULUTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-24",
        "last_updated": "2014-09-24",
        "status": "A",
        "authorized_official_last_name": "BERLO",
        "authorized_official_first_name": "JOSH",
        "authorized_official_title_or_position": "ASST ATH DIR FOR SPORTS MEDICINE",
        "authorized_official_telephone_number": "218-726-8637"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UMD Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Duluth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.