NPIMap

Organization Active NPI

The Duluth Clinic, LTD.

Doing business as Essentia Health Ely Pharmacy

  • Community/Retail Pharmacy
  • Ely, MN
National Provider Identifier
1689349359
Registry record updated Feb 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
THE DULUTH CLINIC, LTD.
Doing business as
Essentia Health Ely Pharmacy
Practice address
1500 E Sheridan St Ste 100
Ely, MN 55731-1855
Phone
(218) 365-7957
Fax
(218) 365-7958
NPI assigned
Aug 13, 2021
Last updated
Feb 28, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 28, 2024

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

Authorized official

Name
Kevin Boren
Title
VP of Finance
Phone
(218) 786-1009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

1500 E Sheridan St Ste 100
Ely, MN 55731-1855

Mailing address

204 Belknap St
Atn: Retail Pharmacy Services
Superior, WI 54880-2905
Phone (218) 786-4265

Other names 1

  • Essentia Health Ely Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20151103001283 MN Part B Supplier - Mass Immunization (Roster Biller Only) 2567374283 16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Virginia, MN; Two Harbors, MN; Silver Bay, MN; International Falls, MN; Hinckley, MN; Hibbing, MN; Hermantown, MN; Grand Rapids, MN…
O20220420001757 MN DME Supplier - Pharmacy 2567374283 Practice locations: Ely, MN

Other NPIs with the same Medicare PAC ID 24

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 24

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Essentia Health Ely Pharmacy1500 E Sheridan St, Ely, MN 55731-1855(218) 365-7957 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Accepts assignmentParticipating since Oct 24, 2022

National Provider Directory

National Provider Directory
Tax ID family
Duluth Clinic-Ely35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1500 E Sheridan St
#100
Ely, MN 55731
Phone (218) 365-7957

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1628812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709078400000",
    "number": "1689349359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 BELKNAP ST",
            "address_2": "ATN: RETAIL PHARMACY SERVICES",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548802905",
            "telephone_number": "218-786-4265",
            "fax_number": "218-786-2198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E SHERIDAN ST STE 100",
            "city": "ELY",
            "state": "MN",
            "postal_code": "557311855",
            "telephone_number": "218-365-7957",
            "fax_number": "218-365-7958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DULUTH CLINIC, LTD.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2021-08-13",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A",
        "authorized_official_last_name": "BOREN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "218-786-1009"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Ely Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Ely Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ely, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.