NPIMap

Individual provider Active NPI

Elisabeth Jane Gibbons, M.D.

  • Family Medicine Physician
  • Duluth, MN
National Provider Identifier
1790042182
Registry record updated Dec 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
56717 Issued in MN
Practice address
4702 Grand Ave
Duluth, MN 55807-2742
Phone
(218) 249-6800
Fax
(218) 249-6808
NPI assigned
Apr 23, 2012
Last updated
Dec 4, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 56717 MN Primary

Addresses

Primary practice location

4702 Grand Ave
Duluth, MN 55807-2742

Mailing address

4702 Grand Ave
Duluth, MN 55807-2742

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address him@slk.direct.slhduluth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, TX2 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
I20130724000945 MN Practitioner - Family Practice 7012158652 Reassigns benefits to 1 organization
I20151024000010 TX Practitioner - Family Practice 7012158652 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Luke's Hospital of DuluthGroup PAC ID 7113834839, 409 clinicians

Practice addresses (Care Compare)

4702 Grand Ave
Duluth, MN 55807-2742
Phone (218) 249-6800

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56717MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke's Hospital of Duluth CurrentSince Oct 17, 2016 Accepting new patients
Ton San Xavier Health Center CurrentSince Aug 15, 2015 Accepting new patients
Ton Sells Hospital CurrentSince Aug 15, 2015 Accepting new patients
Ton San Simon Health Center CurrentSince Aug 15, 2015 Accepting new patients
Ton Santa Rosa Health Center CurrentSince Aug 15, 2015 Accepting new patients
St. Luke's Hospital of Duluth CurrentSince Oct 17, 2016 Accepting new patients
St. Luke's Hospital of Duluth Current Accepting new patients
Ton Santa Rosa Health Center Past Accepting new patients
Ton San Xavier Health Center Past Accepting new patients
Ton Sells Hospital Past Accepting new patients

Locations

7900 S J Stock Rd
Tucson, AZ 85746
Phone (520) 295-2550

29980 Network Pl
Chicago, IL 60673

1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860

324 W Superior St
Ste 220
Duluth, MN 55802
Phone (218) 249-3500

4702 Grand Ave
Duluth, MN 55807
Phone (218) 249-6800

915 E 1st St
Duluth, MN 55805
Phone (218) 249-5352

Interoperability endpoints

  • Direct secure messaging: egibbons237419@direct.aspirus.org
  • Direct secure messaging: him@slk.direct.slhduluth.com

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 31

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1335139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1790042182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4702 GRAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558072742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4702 GRAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558072742",
            "telephone_number": "218-249-6800",
            "fax_number": "218-249-6808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBBONS",
        "first_name": "ELISABETH",
        "middle_name": "JANE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-23",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "56717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@slk.direct.slhduluth.com",
            "affiliation": "N",
            "address_1": "4702 Grand Ave",
            "city": "Duluth",
            "state": "MN",
            "country_code": "US",
            "postal_code": "558072742",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.