NPIMap

Individual provider Active NPI

Nichole Marie Schaefer, MD

  • Family Medicine Physician
  • Duluth, MN
National Provider Identifier
1649220641
Registry record updated Dec 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
42655 Issued in MN
Practice address
4702 Grand Ave
Duluth, MN 55807-2742
Phone
(218) 249-6800
Fax
(218) 249-6808
NPI assigned
May 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

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 42655 MN Primary

Addresses

Primary practice location

4702 Grand Ave
Duluth, MN 55807-2742

Mailing address

4702 Grand Ave
Duluth, MN 55807-2742
Phone (218) 249-6800

Other identifiers 1

IdentifierTypeStateIssuer
223613300MedicaidMN

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
I20070111000457 MN Practitioner - Family Practice 7719984673 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians
St. Luke'S Hospital of DuluthGroup PAC ID 7113834839, 409 clinicians

Practice addresses (Care Compare)

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

4702 Grand Ave
Duluth, MN 55807-2742
Phone (218) 249-6800

Hospital & facility affiliations

  • Aspirus St. Luke'S at Home - Home Care - Duluth Home health agency, Duluth, MN, CCN 247098
  • Aveanna Home Health Home health agency, Duluth, MN, CCN 247029
  • Aspirus St. Luke'S at Home-Hospice-Duluth Hospice, Duluth, MN, CCN 241524
  • St Lukes Hospital Hospital, Duluth, MN, CCN 240047
  • Community Memorial Hospital Hospital, Cloquet, MN, CCN 241364

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
42655MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke'S Hospital of Duluth CurrentSince Jul 1, 2003 Accepting new patients
Lake View Memorial Hospital, Inc CurrentSince May 19, 2020 Accepting new patients
St. Luke'S Hospital of Duluth Current Accepting new patients
Lake View Memorial Hospital, Inc. CurrentSince May 19, 2020 Accepting new patients
St. Luke'S Hospital of Duluth CurrentSince Jul 1, 2003 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

200 Bunker Hill Dr
Aitkin, MN 56431
Phone (218) 927-2121

512 Skyline Blvd
Cloquet, MN 55720
Phone (218) 878-7207

4702 Grand Ave
Duluth, MN 55807
Phone (218) 249-6800

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

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

325 11th Ave
Two Harbors, MN 55616
Phone (218) 834-5520

Interoperability endpoints

  • Direct secure messaging: nschaefer237568@direct.aspirus.org

Organizations & group practices 6

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": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1649220641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4702 GRAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558072742",
            "telephone_number": "218-249-6800",
            "fax_number": "218-249-6808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4702 GRAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558072742",
            "telephone_number": "218-249-6800",
            "fax_number": "218-249-6808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHAEFER",
        "first_name": "NICHOLE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-11",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "42655",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "223613300",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@slk.direct.slhduluth.com",
            "affiliation": "N",
            "address_1": "4702 Grand Ave",
            "city": "Duluth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "558072742",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.