NPIMap

Organization Active NPI

The Duluth Clinic, LTD.

Doing business as Essentia Health Specialty Pharmacy

  • Specialty Pharmacy
  • Superior, WI
National Provider Identifier
1871962282
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Specialty PharmacyTaxonomy code 3336S0011X
License
9348-42 Issued in WI
Legal business name
THE DULUTH CLINIC, LTD.
Doing business as
Essentia Health Specialty Pharmacy
Practice address
204 Belknap St Ste 200
Superior, WI 54880-2905
Phone
(715) 817-7145
Fax
(715) 817-7144
NPI assigned
Sep 16, 2015
Last updated
Feb 29, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 29, 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 7

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 9348-42 WI
Community/Retail Pharmacy 3336C0003X PHAR1337 ND
Community/Retail Pharmacy 3336C0003X 265022 MN
Community/Retail Pharmacy 3336C0003X 4788 IA
Community/Retail Pharmacy 3336C0003X 400-1673 SD
Specialty Pharmacy 3336S0011X 9348-42 WI Primary
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

204 Belknap St Ste 200
Superior, WI 54880-2905

Mailing address

204 Belknap St Ste 200
Superior, WI 54880-2905
Phone (715) 817-7145

Other identifiers 2

IdentifierTypeStateIssuer
1871962282MedicaidMN
100051572MedicaidWI

Other names 1

  • Essentia Health Specialty Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20151230000109 WI Part B Supplier - Mass Immunization (Roster Biller Only) 2567374283 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hayward, WI; Superior, WI
O20160805001124 WI DME Supplier - Pharmacy 2567374283 Practice locations: Superior, WI

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 5

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

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

3500 Tower Ave
Ste B
Superior, WI 54880
Phone (715) 817-7171

Practitioners & affiliated clinicians

Practitioners 1

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": "1442361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1871962282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 BELKNAP ST STE 200",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548802905",
            "telephone_number": "715-817-7145",
            "fax_number": "715-817-7144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 BELKNAP ST STE 200",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548802905",
            "telephone_number": "715-817-7145",
            "fax_number": "715-817-7144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DULUTH CLINIC, LTD.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2015-09-16",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "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": "WI",
            "license": "9348-42",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "ND",
            "license": "PHAR1337",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "265022",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IA",
            "license": "4788",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "SD",
            "license": "400-1673",
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "WI",
            "license": "9348-42",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871962282",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100051572",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Superior, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 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.