NPIMap

Individual provider Active NPI

Jessica Woodward Lavan, MD

  • Family Medicine Physician
  • Cloquet, MN
National Provider Identifier
1831176759
Registry record updated Dec 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
45168 Issued in MN
Practice address
417 Skyline Blvd
Cloquet, MN 55720-1164
Phone
(218) 879-1271
Fax
(218) 879-8904
NPI assigned
Dec 30, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 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 45168 MN Primary

Addresses

Primary practice location

417 Skyline Blvd
Cloquet, MN 55720-1164

Mailing address

417 Skyline Blvd
Cloquet, MN 55720-1164
Phone (218) 879-1271

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jessica.woodward@rcll.eclinicaldirectplus.com

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
I20040726000445 MN Practitioner - Family Practice 4880674191 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

417 Skyline Blvd
Cloquet, MN 55720-1164
Phone (218) 879-1271

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Memorial Hospital Association CurrentSince Jun 1, 2015 Accepting new patients
University of Minnesota Physicians Past Accepting new patients

Locations

417 Skyline Blvd
Cloquet, MN 55720
Phone (218) 879-1271

512 Skyline Blvd
Cloquet, MN 55720
Phone (218) 878-7207

Organizations & group practices 2

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.

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": "1135900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1831176759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 SKYLINE BLVD",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201164",
            "telephone_number": "218-879-1271",
            "fax_number": "218-879-8904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 SKYLINE BLVD",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201164",
            "telephone_number": "218-879-1271",
            "fax_number": "218-879-8904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODWARD LAVAN",
        "first_name": "JESSICA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-30",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "45168",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jessica.woodward@rcll.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "417 Skyline Blvd",
            "city": "Cloquet",
            "state": "MN",
            "country_code": "US",
            "postal_code": "557201164",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cloquet, MN

Sources for this page

Verify at the official NPI Registry.