Individual provider Active NPI

Alyssa Dye, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Duluth, MN
National Provider Identifier
1780201657
Registry record updated Jun 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
2099556 Issued in MN
Practice address
615 Pecan Ave
Duluth, MN 55811-2749
Phone
(218) 355-2100
NPI assigned
Jun 26, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 2099556 MN Primary

Addresses

Primary practice location

615 Pecan Ave
Duluth, MN 55811-2749

Mailing address

1702 University Dr S
Fargo, ND 58103-4940

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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 1

Enrollment IDStateProvider typePAC IDDetails
I20200819001806 MN Practitioner - Nurse Practitioner 5092131128 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

502 E 2ND St
Duluth, MN 55805-1913
Phone (218) 786-8364

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7599MNMDPhysical Therapist
2099556MNMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Duluth Clinic LTD Current Accepting new patients
The Duluth Clinic, LTD. CurrentSince Aug 31, 2020 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
SMDC Medical Center CurrentSince Aug 31, 2020 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
The Duluth Clinic, LTD CurrentSince Aug 31, 2020 Accepting new patients
SMDC Medical Center PastSince Jun 28, 2020 Accepting new patients

Locations

615 Pecan Ave
Duluth, MN 55811
Phone (218) 355-2100

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

502 E 2nd St
Duluth, MN 55805
Phone (218) 727-8762

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

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

1101 9th St N
Virginia, MN 55792
Phone (218) 305-0000

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

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1593129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593129600000",
    "number": "1780201657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 PECAN AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558112749",
            "telephone_number": "218-355-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYE",
        "first_name": "ALYSSA",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-26",
        "last_updated": "2020-06-26",
        "certification_date": "2020-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "2099556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.