NPIMap

Individual provider Active NPI

Kimberly Anne Boddicker, MD

  • Cardiovascular Disease Physician
  • Duluth, MN
National Provider Identifier
1821037946
Registry record updated Dec 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
47480 Issued in MN
Practice address
400 E 3Rd St
Duluth, MN 55805-1951
Phone
(218) 786-3443
NPI assigned
Jun 5, 2006
Last updated
Dec 9, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 47480 MN Primary
Cardiovascular Disease Physician 207RC0000X 47894-20 WI
Cardiovascular Disease Physician 207RC0000X 16931 ND

Addresses

Primary practice location

400 E 3Rd St
Duluth, MN 55805-1951

Mailing address

400 E 3Rd St
SSB-5
Duluth, MN 55805-1951
Phone (218) 786-3146

Other practice location 1

11134 N State Road 77
Hayward, WI 54843-5325
Phone (715) 634-5505

Other practice location 2

3000 32nd Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000

Other identifiers 1

IdentifierTypeStateIssuer
933138700MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI, ND3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20050822000460 MN Practitioner - Cardiovascular Disease (Cardiology) 9032149802 Reassigns benefits to 2 organizations
I20050827000105 WI Practitioner - Cardiovascular Disease (Cardiology) 9032149802 Reassigns benefits to 3 organizations
I20201215003254 ND Practitioner - Cardiovascular Disease (Cardiology) 9032149802 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Iowa, RJ & L Carver College of Medicine, 1999
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
Memorial Medical Center IncGroup PAC ID 8022000447, 80 clinicians
St Marys Medical CenterGroup PAC ID 6901706357, 91 clinicians

Practice addresses (Care Compare)

11134 N State Rd
Hayward, WI 54843-5325
Phone (715) 634-5505

1615 Maple LN
Ashland, WI 54806-3626
Phone (715) 682-5500

402 E 2ND St
Duluth, MN 55805-1906
Phone (218) 786-3443

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
47894-20WIMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary's Hospital of Superior Current Accepting new patients
Innovis Health LLC CurrentSince Dec 1, 2020 Accepting new patients
St. Mary's Duluth Clinic Health System Current Accepting new patients
Innovis Health, LLC CurrentSince Dec 1, 2020 Accepting new patients
The Duluth Clinic, LTD CurrentSince Jul 29, 2005 Accepting new patients
Memorial Medical Center Inc CurrentSince Oct 7, 2022 Accepting new patients
St Marys Medical Center CurrentSince Oct 1, 2024 Accepting new patients
St. Mary's Hospital of Superior CurrentSince Apr 1, 2010 Accepting new patients
Memorial Medical Center Inc CurrentSince Oct 7, 2022 Accepting new patients
St. Mary's Medical Center CurrentSince Oct 1, 2024 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
St. Mary's Medical Center Past Accepting new patients

Locations

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

400 E 3rd St
#5
Duluth, MN 55805

402 E 2nd St
Duluth, MN 55805
Phone (218) 786-3443

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000

1615 Maple Ln
Ashland, WI 54806
Phone (715) 682-4563

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

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

3500 Tower Ave
#1
Superior, WI 54880
Phone (715) 395-5457

3500 Tower Ave
Ste 1
Superior, WI 54880
Phone (715) 395-5457

Organizations & group practices 12

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": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607472000000",
    "number": "1821037946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "address_2": "SSB-5",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-3146"
        },
        {
            "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": "558051951",
            "telephone_number": "218-786-3443"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11134 N State Road 77",
            "address_purpose": "LOCATION",
            "city": "Hayward",
            "state": "WI",
            "postal_code": "548435325",
            "country_code": "US",
            "telephone_number": "715-634-5505",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3000 32nd Ave S",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581036132",
            "country_code": "US",
            "telephone_number": "701-364-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BODDICKER",
        "first_name": "KIMBERLY",
        "middle_name": "ANNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-05",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MN",
            "license": "47480",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "47894-20",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "ND",
            "license": "16931",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "933138700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.