Individual provider Active NPI

Mary Alice Rantala

  • Family Nurse Practitioner
  • Duluth, MN
National Provider Identifier
1720174881
Registry record updated May 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R144413-1 Issued in MN
Practice address
400 E 3Rd St
Duluth, MN 55805
Phone
(218) 786-8364
NPI assigned
Oct 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R144413-1 MN Primary

Addresses

Primary practice location

400 E 3Rd St
Duluth, MN 55805

Mailing address

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI, ND3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20060207000851 MN Practitioner - Nurse Practitioner 5799790077 Reassigns benefits to 2 organizations
I20140711001309 WI Practitioner - Nurse Practitioner 5799790077 Reassigns benefits to 3 organizations
I20220315001969 ND Practitioner - Nurse Practitioner 5799790077 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, shared by 25 NPIs, 1,135 clinicians
Innovis Health LLCGroup PAC ID 9931298155, 561 clinicians

Practice addresses (Care Compare)

400 E 3Rd St
Duluth, MN 55805-1951

4110 51St Ave S
Fargo, ND 58104-7776
Phone (701) 364-3100

901 9TH St N
Virginia, MN 55792-2325
Phone (218) 748-7750

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
R144413-1MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Duluth Clinic LTD CurrentSince May 14, 2018 Accepting new patients
St. Mary'S Hospital of Superior CurrentSince Jan 1, 2026 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Apr 21, 2014 Accepting new patients
Innovis Health LLC CurrentSince Mar 7, 2022 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
St. Mary'S Hospital of Superior CurrentSince Oct 2, 2020 Accepting new patients
Innovis Health LLC CurrentSince Mar 7, 2022 Accepting new patients
Essentia Health Virginia, LLC CurrentSince Jan 20, 2021 Accepting new patients
Innovis Health, LLC Current Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
Essentia Health Virginia, LLC CurrentSince Jan 20, 2021 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
St. Mary'S Duluth Clinic Health System Current Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients

Locations

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

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

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

420 E 1st St
Duluth, MN 55805
Phone (218) 786-1265

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

901 9th St N
Virginia, MN 55792
Phone (218) 741-3340

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

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000

4110 51st Ave S
Fargo, ND 58104
Phone (701) 364-3100

15495 County Road B
Hayward, WI 54843
Phone (715) 634-2641

3500 Tower Ave
Ste 1
Superior, WI 54880
Phone (715) 395-5457

3500 Tower Ave
Superior, WI 54880
Phone (715) 392-8281

Organizations & group practices 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304294400000",
    "number": "1720174881",
    "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": "55805",
            "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": "55805",
            "telephone_number": "218-786-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANTALA",
        "first_name": "MARY",
        "middle_name": "ALICE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2011-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R144413-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.