Individual provider Active NPI

Thomas Mark Nelson, MD

  • Surgery Physician
  • Duluth, MN
National Provider Identifier
1942251202
Registry record updated Mar 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
34418 Issued in MN
Practice address
920 E 1St St
Suite P302
Duluth, MN 55805-2201
Phone
(218) 249-6050
NPI assigned
May 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 34418 MN Primary

Addresses

Primary practice location

920 E 1St St
Suite P302
Duluth, MN 55805-2201

Mailing address

301 Highway 65 S
Mora, MN 55051-1899
Phone (320) 225-3317

Other practice location 1

301 Highway 65 S
Mora, MN 55051-1899
Phone (320) 225-3317

Other identifiers 2

IdentifierTypeStateIssuer
020052636OtherMNMEDICARE RR
732708100MedicaidMN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tnelson179342@excellian.direct.allina.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34418MNMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Luke'S Hospital of Duluth Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614643200000",
    "number": "1942251202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 HIGHWAY 65 S",
            "city": "MORA",
            "state": "MN",
            "postal_code": "550511899",
            "telephone_number": "320-225-3317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 E 1ST ST",
            "address_2": "SUITE P302",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052201",
            "telephone_number": "218-249-6050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 Highway 65 S",
            "address_purpose": "LOCATION",
            "city": "Mora",
            "state": "MN",
            "postal_code": "550511899",
            "country_code": "US",
            "telephone_number": "320-225-3317",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NELSON",
        "first_name": "THOMAS",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MN",
            "license": "34418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "020052636",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "732708100",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tnelson179342@excellian.direct.allina.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/PDF/TXT",
            "address_1": "301 Highway 65 S",
            "city": "Mora",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550511899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.