Active NPI
Diane Rose Duckworth, MD
- Obstetrics & Gynecology Physician
- Saint Cloud, MN
National Provider Identifier
1629173166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 46347
- Practice address
- 1301 33Rd St S
Saint Cloud, MN 56301-9668 - Phone
- (320) 251-8181
- Fax
- (320) 251-6942
- NPI assigned
- Sep 13, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 46347 | MN | Primary |
Addresses
Primary practice location
1301 33Rd St S
Saint Cloud, MN 56301-9668
Mailing address
251 County Rd 120
Saint Cloud, MN 56303-4813
Phone (320) 202-8949
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 659457300 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46347 | MN | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medical Scanning Consultants PA | Past | Accepting new patients | |
| Centracare Clinic | Past | Accepting new patients | |
| Centracare Clinic | Past | Accepting new patients | |
| Rice Memorial Hospital | Past | Accepting new patients |
Organizations & group practices 4
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.
-
- Multi-Specialty Clinic/Center
- St Joseph, MN
- NPI 1134121759
-
- Multi-Specialty Clinic/Center
- Saint Cloud, MN
- NPI 1225030844
-
- General Acute Care Hospital
- Willmar, MN
- NPI 1619064193
-
- Diagnostic Radiology Physician
- Federal Way, WA
- NPI 1730156175
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1290470400000",
"number": "1629173166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "251 COUNTY RD 120",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563034813",
"telephone_number": "320-202-8949",
"fax_number": "320-202-0756"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 33RD ST S",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563019668",
"telephone_number": "320-251-8181",
"fax_number": "320-251-6942"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUCKWORTH",
"first_name": "DIANE",
"middle_name": "ROSE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-13",
"last_updated": "2010-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "MN",
"license": "46347",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "659457300",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.