NPIMap

Individual provider Active NPI

Bryan Kevin Koenig, DO

  • Internal Medicine Physician
  • Duluth, MN
National Provider Identifier
1801380928
Registry record updated Jul 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
66464 Issued in MN
Practice address
407 E 3Rd St
Duluth, MN 55805-1950
Phone
(218) 786-4000
NPI assigned
Jun 21, 2018
Last updated
Jul 21, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X 66464 MN Primary

Addresses

Primary practice location

407 E 3Rd St
Duluth, MN 55805-1950

Mailing address

SSB-6
400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210714000185 MN Practitioner - Hospitalist 0244589547 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2018
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
Northern Pines Medical CenterGroup PAC ID 3870565641, shared by 4 NPIs, 39 clinicians

Practice addresses (Care Compare)

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

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

5211 Hwy 110
Aurora, MN 55705-1522
Phone (218) 229-3311

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29346MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Duluth Clinic LTD CurrentSince Aug 2, 2021 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Aug 2, 2021 Accepting new patients
Pine Medical Center Current Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
St Marys Medical Center Past Accepting new patients

Locations

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

407 E 3rd St
Duluth, MN 55805
Phone (218) 786-4357

705 Lundorff Dr
Sandstone, MN 55072
Phone (320) 245-2211

Organizations & group practices 6

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 12

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": "1529539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626825600000",
    "number": "1801380928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "SSB-6",
            "address_2": "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": "407 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051950",
            "telephone_number": "218-786-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOENIG",
        "first_name": "BRYAN",
        "middle_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-21",
        "last_updated": "2021-07-21",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "66464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.