NPIMap

Organization Active NPI

Essentia Health Virginia, LLC

Doing business as Essentia Health Ely Clinic

  • Multi-Specialty Clinic/Center
  • Ely, MN
National Provider Identifier
1962440362
Registry record updated Dec 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
ESSENTIA HEALTH VIRGINIA, LLC
Doing business as
Essentia Health Ely Clinic
Practice address
300 W Conan St
Ely, MN 55731-1145
Phone
(218) 365-7900
NPI assigned
Jun 4, 2006
Last updated
Dec 13, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
SMDC HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 13, 2016

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

Authorized official

Name
Daniel Nikcevich
Title
President
Phone
(218) 786-2628

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

300 W Conan St
Ely, MN 55731-1145

Mailing address

300 W Conan St
Ely, MN 55731-1145
Phone (218) 365-7900

Other identifiers 1

IdentifierTypeStateIssuer
1962440362MedicaidMN

Other names 1

  • Essentia Health Ely Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031103000229 MN Part B Supplier - Clinic/Group Practice 2567374283 Receives reassigned benefits from 1,610 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20130306000467 MN Part B Supplier - Clinic/Group Practice 7810149002 Receives reassigned benefits from 193 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Babbitt, MN; Ely, MN; International Falls, MN; Virginia, MN

Other NPIs on the same Medicare enrollment 26

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

View all 26

National Provider Directory

National Provider Directory
Part of
St Marys Duluth Clinic Health System

Member of 1

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

Locations

300 W Conan St
Ely, MN 55731
Phone (218) 365-7900

300 W Conan St
#3764
Ely, MN 55731
Phone (218) 365-7900

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481587200000",
    "number": "1962440362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W CONAN ST",
            "city": "ELY",
            "state": "MN",
            "postal_code": "557311145",
            "telephone_number": "218-365-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W CONAN ST",
            "city": "ELY",
            "state": "MN",
            "postal_code": "557311145",
            "telephone_number": "218-365-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESSENTIA HEALTH VIRGINIA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SMDC HEALTH SYSTEM",
        "enumeration_date": "2006-06-04",
        "last_updated": "2016-12-13",
        "status": "A",
        "authorized_official_last_name": "NIKCEVICH",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-786-2628"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962440362",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Ely Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ely, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2016; 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.