NPIMap

Individual provider Active NPI

Trevor John Diercks, DO

  • Family Medicine Physician
  • Two Harbors, MN
National Provider Identifier
1952864076
Registry record updated Aug 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
72290 Issued in MN
Practice address
325 11TH Ave
Two Harbors, MN 55616-1300
Phone
(218) 249-5555
NPI assigned
Apr 8, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 74574 WI
Family Medicine Physician 207Q00000X 7908 WI
Family Medicine Physician 207Q00000X 72290 MN Primary

Addresses

Primary practice location

325 11TH Ave
Two Harbors, MN 55616-1300

Mailing address

325 11TH Ave
Two Harbors, MN 55616-1300
Phone (218) 249-5555

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address tdiercks420701@ehrdirect.mayoclinicmsg.org
Direct Messaging Address tdiercks420701@ehrdirect.mayoclinicmsg.org
Direct Messaging Address him@lkv.direct.slhduluth.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
I20220906001556 MN Practitioner - Family Practice 7012241797 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Luke'S Hospital of DuluthGroup PAC ID 7113834839, 409 clinicians

Practice addresses (Care Compare)

1011 E 1St St
Duluth, MN 55805-2242
Phone (218) 249-7000

1015 E 1St St
Duluth, MN 55805-2242
Phone (218) 249-7860

325 11TH Ave
Two Harbors, MN 55616-1300
Phone (218) 834-7300

Hospital & facility affiliations

  • Aspirus St. Luke'S at Home - Home Care - Duluth Home health agency, Duluth, MN, CCN 247098
  • Aspirus St. Luke'S at Home-Hospice-Duluth Hospice, Duluth, MN, CCN 241524
  • Moments Hospice Hospice, Hermantown, MN, CCN 241609
  • Aspirus Lake View Hospital Hospital, Two Harbors, MN, CCN 241308
  • St Lukes Hospital Hospital, Duluth, MN, CCN 240047
  • Aspirus Lake View Hospital Nursing home, CCN 24Z308
  • The Waterview Shores LLC Nursing home, Two Harbors, MN, CCN 245471

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions16
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
74574WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake View Memorial Hospital, Inc Family Medicine CurrentSince Aug 24, 2022 Accepting new patients
St. Luke'S Hospital of Duluth CurrentSince Apr 1, 2025 Accepting new patients
Lake View Memorial Hospital, Inc. CurrentSince Aug 24, 2022 Accepting new patients
St. Luke'S Hospital of Duluth Current Accepting new patients
St. Luke'S Hospital of Duluth CurrentSince Apr 1, 2025 Accepting new patients
Lake View Memorial Hospital, Inc Current Accepting new patients
St. Luke'S Hospital of Duluth Family Medicine Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

915 E 1st St
Duluth, MN 55805
Phone (218) 249-5352

1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860

325 11th Ave
Two Harbors, MN 55616
Phone (218) 834-5520

Interoperability endpoints

  • Direct secure messaging: tdiercks237402@direct.aspirus.org
  • Direct secure messaging: tdiercks420701@ehrdirect.mayoclinicmsg.org

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 34

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1554681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659916800000",
    "number": "1952864076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 11TH AVE",
            "city": "TWO HARBORS",
            "state": "MN",
            "postal_code": "556161300",
            "telephone_number": "218-249-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 11TH AVE",
            "city": "TWO HARBORS",
            "state": "MN",
            "postal_code": "556161300",
            "telephone_number": "218-249-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIERCKS",
        "first_name": "TREVOR",
        "middle_name": "JOHN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-08",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "74574",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "7908",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "72290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tdiercks420701@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "191 Theater Rd",
            "city": "Onalaska",
            "state": "WI",
            "country_code": "US",
            "postal_code": "546508679",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tdiercks420701@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "815 10th St S",
            "city": "LA Crosse",
            "state": "WI",
            "country_code": "US",
            "postal_code": "546014764",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "him@lkv.direct.slhduluth.com",
            "affiliation": "N",
            "address_1": "325 11th Ave",
            "city": "Two Harbors",
            "state": "MN",
            "country_code": "US",
            "postal_code": "556161300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Two Harbors, MN

Sources for this page

Verify at the official NPI Registry.