NPIMap

Individual provider Active NPI

Romy Jose Thekkekara, MD

  • Medical Oncology Physician
  • Duluth, MN
National Provider Identifier
1770915605
Registry record updated Sep 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
License
036-139928 Issued in IL
Practice address
400 E 3Rd St
Duluth, MN 55805
Phone
(218) 786-8364
NPI assigned
Aug 1, 2013
Last updated
Sep 28, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2020

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125063494 IL
Hematology (Internal Medicine) Physician 207RH0000X 036-139928 IL
Medical Oncology Physician 207RX0202X 65516 MN
Medical Oncology Physician 207RX0202X 036-139928 IL Primary

Addresses

Primary practice location

400 E 3Rd St
Duluth, MN 55805

Mailing address

400 E 3Rd St
Duluth, MN 55805-1951

Other practice location 1

1901 W Harrison St
John H Stroger, Jr. Hospital of Cook County
Chicago, IL 60612-3714
Phone (313) 864-0394

Other practice location 2

1901 W Harrison St
John H Stroger, Jr. Hospital of Cook County
Chicago, IL 60612-3714
Phone (313) 864-0394

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
I20190617001794 MN Practitioner - Medical Oncology 5799081923 Reassigns benefits to 1 organization
I20200603000381 WI Practitioner - Hematology/Oncology 5799081923 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Marys Hospital of SuperiorGroup PAC ID 8628964228, 96 clinicians
Polinsky Medical Rehabilitation CenterGroup PAC ID 0941377360, 369 clinicians
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

1180 Chandler Dr
Spooner, WI 54801-2204
Phone (715) 635-2151

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

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

819 Ash St
Spooner, WI 54801-1201
Phone (715) 635-5303

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125063494ILMDInternal Medicine Physician
036-139928ILMDHematology (Internal Medicine) Physician
65516MNMDMedical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Mary's Hospital of Superior CurrentSince Apr 1, 2024 Accepting new patients
St. Mary's Hospital of Superior Current Accepting new patients
The Duluth Clinic LTD CurrentSince Jul 1, 2019 Accepting new patients
St. Mary's Duluth Clinic Health System Current Accepting new patients
The Duluth Clinic, LTD. CurrentSince Jul 1, 2019 Accepting new patients
St. Mary's Hospital of Superior CurrentSince Apr 1, 2024 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients

Locations

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

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

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

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1375315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601251200000",
    "number": "1770915605",
    "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"
        },
        {
            "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": [
        {
            "address_1": "1901 W Harrison St",
            "address_2": "John H Stroger, Jr. Hospital of Cook County",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606123714",
            "country_code": "US",
            "telephone_number": "313-864-0394",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1901 W Harrison St",
            "address_2": "John H Stroger, Jr. Hospital of Cook County",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606123714",
            "country_code": "US",
            "telephone_number": "313-864-0394",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEKKEKARA",
        "first_name": "ROMY",
        "middle_name": "JOSE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-01",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125063494",
            "primary": false
        },
        {
            "code": "207RH0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology",
            "state": "IL",
            "license": "036-139928",
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "MN",
            "license": "65516",
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "IL",
            "license": "036-139928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.