Individual provider Active NPI

William O Haug Jr., M.D.

  • Sports Medicine (Family Medicine) Physician
  • Cloquet, MN
National Provider Identifier
1922084284
Registry record updated Dec 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
10460 Issued in ND
Practice address
512 Skyline Blvd
Cloquet, MN 55720-1199
Phone
(218) 879-4641
NPI assigned
Dec 19, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2020

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 46850-020 WI
Family Medicine Physician 207Q00000X 42654 MN
Family Medicine Physician 207Q00000X 5007 AK
Sports Medicine (Family Medicine) Physician 207QS0010X 10756 MT
Sports Medicine (Family Medicine) Physician 207QS0010X 10460 ND Primary

Addresses

Primary practice location

512 Skyline Blvd
Cloquet, MN 55720-1199

Mailing address

512 Skyline Blvd
Cloquet, MN 55720-1199
Phone (218) 879-4641

Other identifiers 1

IdentifierTypeStateIssuer
0147339MedicaidMT

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hisdept@direct.cloquethospital.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031218000115 MN Practitioner - Family Practice 3577460476 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Dakota School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Memorial Hospital AssociationGroup PAC ID 0042129991, 47 clinicians

Practice addresses (Care Compare)

512 Skyline Blvd
Cloquet, MN 55720-3787
Phone (218) 879-4641

Hospital & facility affiliations

  • Community Memorial Hospital Hospital, Cloquet, MN, CCN 241364

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5007AKMDFamily Medicine Physician
46850-020WIMDFamily Medicine Physician
10756MTMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Memorial Hospital Association CurrentSince May 1, 2019 Accepting new patients

Locations

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

Interoperability endpoints

  • Direct secure messaging: hisdept@direct.cloquethospital.com

Organizations & group practices 1

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 1

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": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606780800000",
    "number": "1922084284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 SKYLINE BLVD",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201199",
            "telephone_number": "218-879-4641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 SKYLINE BLVD",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201199",
            "telephone_number": "218-879-4641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAUG",
        "first_name": "WILLIAM",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-19",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "46850-020",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "42654",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "5007",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MT",
            "license": "10756",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "ND",
            "license": "10460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0147339",
            "state": "MT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hisdept@direct.cloquethospital.com",
            "affiliation": "N",
            "address_1": "512 Skyline Blvd",
            "city": "Cloquet",
            "state": "MN",
            "country_code": "US",
            "postal_code": "557201199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cloquet, MN

Sources for this page

Verify at the official NPI Registry.