NPIMap

Individual provider Active NPI

Ingrid Louisa Nisswandt-Larsen, MD

  • Family Medicine Physician
  • Duluth, MN
National Provider Identifier
1548351406
Registry record updated Oct 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
32323 Issued in MN
Practice address
4621 E Superior St
Duluth, MN 55804-2338
Phone
(218) 786-3550
NPI assigned
Sep 27, 2006
Last updated
Oct 11, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 32323 MN Primary

Addresses

Primary practice location

4621 E Superior St
Duluth, MN 55804-2338

Mailing address

4621 E Superior St
Duluth, MN 55804-2338
Phone (218) 786-3550

Other identifiers 1

IdentifierTypeStateIssuer
922593500MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070822000449 MN Practitioner - Family PracticePractitioner - Geriatric Medicine 9830281989 Reassigns benefits to 1 organization
I20221101001307 WI Practitioner - Geriatric Medicine 9830281989 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Geriatric Medicine
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians
St Marys Hospital of SuperiorGroup PAC ID 8628964228, 96 clinicians
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

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

3500 Tower Ave
Superior, WI 54880-4491
Phone (715) 392-8281

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
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary's Hospital of Superior Current Accepting new patients
The Duluth Clinic LTD CurrentSince Sep 2, 2019 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Sep 2, 2019 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
St. Mary's Hospital of Superior CurrentSince Aug 29, 2022 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
Duluth Nursing and Rehabilitation Center, LLC Past Accepting new patients
Duluth Nursing and Rehabilitation Center, LLC Past Accepting new patients

Locations

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

4621 E Superior St
Duluth, MN 55804
Phone (218) 786-3550

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

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

Organizations & group practices 9

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 11

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": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349913600000",
    "number": "1548351406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4621 E SUPERIOR ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558042338",
            "telephone_number": "218-786-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4621 E SUPERIOR ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558042338",
            "telephone_number": "218-786-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISSWANDT-LARSEN",
        "first_name": "INGRID",
        "middle_name": "LOUISA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2012-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "32323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "922593500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.