NPIMap

Individual provider Active NPI

Ann Caroline Sudoh

  • Sports Medicine (Family Medicine) Physician
  • Duluth, MN
National Provider Identifier
1730124678
Registry record updated May 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
40819 Issued in MN
Practice address
400 E 3Rd St
Duluth, MN 55805-1951
Phone
(218) 786-8364
NPI assigned
Jun 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 40819 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

Other identifiers 1

IdentifierTypeStateIssuer
748031800MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20051129000763 MN Practitioner - Sports MedicinePractitioner - Family Practice 7012937519 Reassigns benefits to 1 organization
I20060825000078 WI Practitioner - Sports MedicinePractitioner - Family Practice 7012937519 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Sports MedicineAlso: Family Practice
Education
University of Minnesota Medical School, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

1600 Miller Trunk Hwy
Duluth, MN 55811-5640
Phone (218) 786-5360

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

Hospital & facility affiliations

  • St Marys Hospital Superior Hospital, Superior, WI, CCN 521329
  • Essentia Health Duluth Hospital, Duluth, MN, CCN 240019
  • Essentia Health St Mary'S Medical Center Hospital, Duluth, MN, CCN 240002
  • Essentia Health Moose Lake Hospital, Moose Lake, MN, CCN 241350

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary'S Hospital of Superior Current Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
The Duluth Clinic, LTD. CurrentSince Sep 30, 2002 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
The Duluth Clinic, LTD CurrentSince Sep 30, 2002 Accepting new patients
St. Mary'S Hospital of Superior CurrentSince Apr 9, 2010 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
The Duluth Clinic, LTD Past Accepting new patients

Locations

330 N 8th Ave E
Duluth, MN 55805
Phone (218) 529-9122

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

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

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

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

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

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 12

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.

Hospital & facility affiliations 6

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": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304899200000",
    "number": "1730124678",
    "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": "SUDOH",
        "first_name": "ANN",
        "middle_name": "CAROLINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-17",
        "last_updated": "2011-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MN",
            "license": "40819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "748031800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.