Jeffrey Allen Wilt, MD
Individual provider Active NPI Family Medicine Physician · Ely, MN
NPI 1720151004 · NPPES record last updated May 5, 2011
Key facts
- NPI
- 1720151004
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 50360 (MN)
- Practice address
- 300 W Conan St
Ely, MN 55731-1145 - Phone
- (218) 365-7900
- NPI assigned
- Nov 16, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Minnesota Medical School, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Essentia Health Virginia LLC
Practice addresses (Care Compare)
300 W Conan St
Ely, MN 55731-1145
Phone (218) 365-7900
901 9TH St N
Virginia, MN 55792-2325
Phone (218) 741-3340
Hospital & facility affiliations
- Ely - Bloomenson Community Hospital
- Essentia Health Virginia
- Ely - Bloomenson Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071217000368 | MN | Practitioner - Family Practice | 7113815846 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50360 | MN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Essentia Health Virginia, LLC | Current |
Accepting new patients | |
| Ely-Bloomenson Community Hospital | Current | Accepting new patients | |
| Essentia Health Virginia, LLC | Current |
Accepting new patients |
Locations
405 W 3rd Ave N
Aurora, MN 55705
Phone (218) 229-3311
71 South Dr
Babbitt, MN 55706
Phone (218) 362-6683
400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364
300 W Conan St
Ely, MN 55731
Phone (218) 365-7900
328 W Conan St
Ely, MN 55731
Phone (218) 365-3271
901 9th St N
Virginia, MN 55792
Phone (218) 741-3340
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 50360 | MN | Yes |
Addresses
Primary practice location
300 W Conan St
Ely, MN 55731-1145
Mailing address
300 W Conan St
Ely, MN 55731-1145
Phone (218) 365-7900
Other providers in Ely, MN
- White Pines Play Collaborative
- Spencer Wihlm
- William J Scott DDS PA
- Kathleen Michelle Willis
- Beth Wilmunen
- Margaret Eileen York-Jesme
All providers in Ely, MN · Family Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.