NPIMap

Individual provider Active NPI

Liv Petra Bly, PA-C

  • Physician Assistant
  • Duluth, MN
National Provider Identifier
1700533254
Registry record updated Jun 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13991 Issued in MN
Practice address
400 E 3Rd St
Duluth, MN 55805-1951
Phone
(218) 786-8364
NPI assigned
Mar 4, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 13991 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
I20220622001413 MN Practitioner - Physician Assistant 7618356601 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
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
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

1001 E Superior St
Suite 201
Duluth, MN 55802-2228
Phone (218) 279-6230

1011 E 1St St
Duluth, MN 55805-2242
Phone (218) 249-7000

1015 E 1St St
Duluth, MN 55805-2242
Phone (218) 249-7860

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

8373 Unity Dr
Virginia, MN 55792-4005
Phone (218) 748-7480

915 E 1St St
Duluth, MN 55805-2107
Phone (218) 249-5439

Hospital & facility affiliations

  • St Lukes Hospital Hospital, Duluth, MN, CCN 240047
  • St Marys Hospital Superior Hospital, Superior, WI, CCN 521329
  • Aspirus Lake View Hospital Hospital, Two Harbors, MN, CCN 241308

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Lake View Memorial Hospital, Inc. CurrentSince Aug 15, 2025 Accepting new patients
Lake View Memorial Hospital, Inc CurrentSince Aug 15, 2025 Accepting new patients
The Duluth Clinic LTD CurrentSince Jul 18, 2022 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
The Duluth Clinic, LTD. CurrentSince Jul 18, 2022 Accepting new patients
Deer River Healthcare Center, Inc. CurrentSince Jul 18, 2022 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
St. Luke'S Hospital of Duluth CurrentSince Jul 31, 2024 Accepting new patients
Deer River Healthcare Center, Inc. CurrentSince Jul 18, 2022 Accepting new patients
St. Luke'S Hospital of Duluth CurrentSince Jul 31, 2024 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

115 10th Ave NE
#A
Deer River, MN 56636
Phone (218) 246-8275

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

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

4212 Grand Ave
Duluth, MN 55807
Phone (218) 786-3500

4855 W Arrowhead Rd
Hermantown, MN 55811
Phone (218) 786-3540

730 E 34th St
Hibbing, MN 55746
Phone (218) 262-3425

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

603 9th St N
Virginia, MN 55792
Phone (218) 741-3013

Interoperability endpoints

  • Direct secure messaging: lbly350398@direct.aspirus.org

Organizations & group practices 44

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.

View all 44

Hospital & facility affiliations 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1646352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654819200000",
    "number": "1700533254",
    "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": "BLY",
        "first_name": "LIV",
        "middle_name": "PETRA",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-04",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.