NPIMap

Individual provider Active NPI

Kerry John Sopoci, PSYD

  • Counselor
  • Duluth, MN
National Provider Identifier
1639129539
Registry record updated Jan 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
LP4446 Issued in MN
Practice address
220 N 6TH Ave E
Duluth, MN 55805-1952
Phone
(218) 249-7000
NPI assigned
May 11, 2006
Last updated
Jan 19, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X LP4446 MN Primary

Addresses

Primary practice location

220 N 6TH Ave E
Duluth, MN 55805-1952

Mailing address

220 N 6TH Ave E
Duluth, MN 55805-1952
Phone (218) 249-7000

Other identifiers 1

IdentifierTypeStateIssuer
797625900MedicaidMN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address him@slk.direct.slhduluth.com

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
I20111201000613 MN Practitioner - Clinical Psychologist 8820262819 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St. Luke's Hospital of DuluthGroup PAC ID 7113834839, 409 clinicians

Practice addresses (Care Compare)

915 E 1St St
Duluth, MN 55805-2107
Phone (218) 249-5555

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke's Hospital of Duluth CurrentSince May 19, 2003 Accepting new patients
St. Luke's Hospital of Duluth CurrentSince May 19, 2003 Accepting new patients
St. Luke's Hospital of Duluth Current Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860

220 N 6th Ave E
Duluth, MN 55805
Phone (218) 249-7000

915 E 1st St
Duluth, MN 55805
Phone (218) 249-5352

Interoperability endpoints

  • Direct secure messaging: him@slk.direct.slhduluth.com

Organizations & group practices 3

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 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611014400000",
    "number": "1639129539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 N 6TH AVE E",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051952",
            "telephone_number": "218-249-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 N 6TH AVE E",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051952",
            "telephone_number": "218-249-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOPOCI",
        "first_name": "KERRY",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MN",
            "license": "LP4446",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "797625900",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@slk.direct.slhduluth.com",
            "affiliation": "N",
            "address_1": "220 N 6th Ave E",
            "city": "Duluth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "558051952",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.