NPIMap

Organization Active NPI

The Duluth Clinic LTD

Doing business as Essentia Health Grand Rapids Pharmacy

  • Community/Retail Pharmacy
  • Grand Rapids, MN
National Provider Identifier
1831690346
Registry record updated Feb 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
THE DULUTH CLINIC LTD
Doing business as
Essentia Health Grand Rapids Pharmacy
Practice address
1542 Golf Course Rd Ste 205
Grand Rapids, MN 55744-3555
Phone
(218) 322-6210
Fax
(218) 322-6211
NPI assigned
Feb 21, 2018
Last updated
Feb 28, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 28, 2024

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

Authorized official

Name
Kevin Boren
Title
VP of Finance
Phone
(218) 786-1009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

1542 Golf Course Rd Ste 205
Grand Rapids, MN 55744-3555

Mailing address

1542 Golf Course Rd Ste 205
Grand Rapids, MN 55744-3555
Phone (218) 322-6210

Other names 1

  • Essentia Health Grand Rapids Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20151103001283 MN Part B Supplier - Mass Immunization (Roster Biller Only) 2567374283 16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Virginia, MN; Two Harbors, MN; Silver Bay, MN; International Falls, MN; Hinckley, MN; Hibbing, MN; Hermantown, MN; Grand Rapids, MN…
O20180524000567 MN DME Supplier - Pharmacy 2567374283 Practice locations: Grand Rapids, MN

Other NPIs with the same Medicare PAC ID 24

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 24

Other NPIs on the same Medicare enrollment 16

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Deer River Community CL35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1542 Golf Course Rd
Ste 205
Grand Rapids, MN 55744
Phone (218) 322-6210

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1519171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709078400000",
    "number": "1831690346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1542 GOLF COURSE RD STE 205",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443555",
            "telephone_number": "218-322-6210",
            "fax_number": "218-322-6211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1542 GOLF COURSE RD STE 205",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443555",
            "telephone_number": "218-322-6210",
            "fax_number": "218-322-6211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DULUTH CLINIC LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2018-02-21",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A",
        "authorized_official_last_name": "BOREN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "218-786-1009"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Grand Rapids Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Rapids, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.