NPIMap

Individual provider Active NPI

Adam M Wennersten, PA-C

  • Physician Assistant
  • Superior, WI
National Provider Identifier
1568619682
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2366-23 Issued in WI
Practice address
2222 E 5TH St
Superior, WI 54880-3709
Phone
(715) 392-1955
Fax
(715) 392-1935
NPI assigned
Aug 20, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 11324 MN
Physician Assistant 363A00000X 2366-23 WI Primary

Addresses

Primary practice location

2222 E 5TH St
Superior, WI 54880-3709

Mailing address

2222 E 5TH St
Superior, WI 54880-3709
Phone (715) 392-1955

Other practice location 1

8170 33rd Ave S
Bloomington, MN 55425-4516
Phone (877) 440-1001

Other practice location 2

4325 Grand Ave
Duluth, MN 55807-2730
Phone (218) 722-1497

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 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
I20090202000263 WI Practitioner - Physician Assistant 6709954324 Reassigns benefits to 1 organization
I20130506000081 MN Practitioner - Physician Assistant 6709954324 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Superior Community Health Center 11 clinicians

Practice addresses (Care Compare)

2222 E 5TH St
Superior, WI 54880-3709
Phone (715) 392-1955

Hospital & facility affiliations

  • St Marys Hospital Superior Hospital, Superior, WI, CCN 521329
  • Essentia Health St Mary'S Medical Center Hospital, Duluth, MN, CCN 240002
  • St Lukes Hospital Hospital, Duluth, MN, CCN 240047

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Superior Community Health Center CurrentSince Jun 1, 2018 Accepting new patients
Allina Health System CurrentSince Mar 31, 2018 Accepting new patients
Allina Health System CurrentSince Mar 31, 2018 Accepting new patients
Allina Health System CurrentSince Dec 31, 2022 Accepting new patients
Aspirus Ironwood Hospital & Clinics, Inc. Past Accepting new patients
Vickers Eyecare, Inc PastSince Jul 1, 2020 Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

4325 Grand Ave
Duluth, MN 55807
Phone (218) 628-7035

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

3600 Tower Ave
Superior, WI 54880
Phone (715) 392-1955

2222 E 5th St
Superior, WI 54880
Phone (715) 392-1955

1500 N 34th St
Ste 200
Superior, WI 54880
Phone (715) 392-8216

Interoperability endpoints

  • Direct secure messaging: awennersten814063@direct.ochin.org

Organizations & group practices 10

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 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1219190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1568619682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 E 5TH ST",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548803709",
            "telephone_number": "715-392-1955",
            "fax_number": "715-392-1935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 E 5TH ST",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548803709",
            "telephone_number": "715-392-1955",
            "fax_number": "715-392-1935"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8170 33rd Ave S",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "MN",
            "postal_code": "554254516",
            "country_code": "US",
            "telephone_number": "877-440-1001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4325 Grand Ave",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558072730",
            "country_code": "US",
            "telephone_number": "218-722-1497",
            "fax_number": "218-722-6239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WENNERSTEN",
        "first_name": "ADAM",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-20",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11324",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2366-23",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Superior, WI

Sources for this page

Verify at the official NPI Registry.