NPIMap

Individual provider Active NPI

Ryan Clark, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Duluth, MN
National Provider Identifier
1689061822
Registry record updated Jul 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
71069 Issued in MN
Practice address
400 E 3Rd St
Duluth, MN 55805-1951
Phone
(218) 786-8364
NPI assigned
Apr 24, 2015
Last updated
Jul 8, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 71069 MN Primary

Addresses

Primary practice location

400 E 3Rd St
Duluth, MN 55805-1951

Mailing address

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

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
I20220721002315 MN Practitioner - Thoracic Surgery 1254652068 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Thoracic Surgery
Education
University of Minnesota Medical School, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Marys Medical CenterGroup PAC ID 6901706357, 91 clinicians

Practice addresses (Care Compare)

402 E 2ND St
Duluth, MN 55805-1906
Phone (218) 786-3443

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
71069MNMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Duluth Clinic, LTD. CurrentSince Aug 22, 2022 Accepting new patients
St Marys Medical Center Current Accepting new patients
St. Mary's Medical Center CurrentSince Oct 1, 2024 Accepting new patients
The Duluth Clinic LTD CurrentSince Aug 22, 2022 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients

Locations

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

402 E 2nd St
Duluth, MN 55805
Phone (218) 786-3443

Organizations & group practices 5

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 7

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": "1429833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657238400000",
    "number": "1689061822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-24",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MN",
            "license": "71069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.