Individual provider Active NPI

Benjamin David Nelson, MD

  • Sports Medicine (Family Medicine) Physician
  • Duluth, MN
National Provider Identifier
1750465985
Registry record updated May 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
47738 Issued in MN
Practice address
400 East 3Rd Street
Duluth, MN 55805
Phone
(218) 786-3520
NPI assigned
Oct 24, 2006
Sex
Male
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 47738 MN Primary

Addresses

Primary practice location

400 East 3Rd Street
Duluth, MN 55805

Mailing address

400 East 3Rd Street
Duluth, MN 55805
Phone (218) 786-3520

Other identifiers 4

IdentifierTypeStateIssuer
34680600MedicaidWI
634T3NEOtherMNBCBS
290422500MedicaidMN
HP54875OtherMNHEALTHPARTNERS

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050822001066 MN Practitioner - Sports MedicinePractitioner - Family Practice 8022049857 Reassigns benefits to 2 organizations
I20130205000288 WI Practitioner - Sports MedicinePractitioner - Family Practice 8022049857 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Sports MedicineAlso: Family Practice
Education
University of Minnesota Medical School, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
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

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary'S Duluth Clinic Health System Current Accepting new patients
St. Mary'S Hospital of Superior CurrentSince Jan 1, 2017 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
The Duluth Clinic LTD CurrentSince Jun 16, 2009 Accepting new patients
St. Mary'S Hospital of Superior CurrentSince Jan 1, 2017 Accepting new patients
Essentia Health Virginia, LLC CurrentSince Dec 1, 2016 Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients

Locations

4621 E Superior St
Duluth, MN 55804
Phone (218) 786-3550

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

300 W Conan St
Ely, MN 55731
Phone (218) 365-7900

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

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

11134 N State Road 77
Hayward, WI 54843
Phone (715) 634-5505

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 9

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 5

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": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304899200000",
    "number": "1750465985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 EAST 3RD STREET",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "55805",
            "telephone_number": "218-786-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 EAST 3RD STREET",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "55805",
            "telephone_number": "218-786-3520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "BENJAMIN",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2011-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MN",
            "license": "47738",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34680600",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "634T3NE",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290422500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP54875",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.