NPIMap

Organization Active NPI

Duluth Graduate Medical Education Council Inc

  • Family Medicine Physician
  • Duluth, MN
National Provider Identifier
1972585867
Registry record updated May 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DULUTH GRADUATE MEDICAL EDUCATION COUNCIL INC
Practice address
330 N 8TH Ave E
Duluth, MN 55805-2024
Phone
(218) 723-1112
Fax
(218) 529-9120
NPI assigned
Nov 16, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2023

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

Authorized official

Name
Shailendra Prasad, MD
Title
Board Chair
Phone
(612) 624-7629

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

330 N 8TH Ave E
Duluth, MN 55805-2024

Mailing address

330 N 8TH Ave E
Duluth, MN 55805-2024
Phone (218) 723-1112

Other identifiers 3

IdentifierTypeStateIssuer
32674900MedicaidWI
647010600MedicaidMN
69226FAOtherMNBCBSMN

Other names 1

  • Duluth Family Medicine Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040116000311 MN Part B Supplier - Clinic/Group Practice 4385545953 Receives reassigned benefits from 54 practitioners
Practice locations: Duluth, MN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0403975Duluth Family Medicine Clinic330 North Eighth Avenue East, Duluth, MN 55805AccreditationDec 22, 2027

National Provider Directory

National Provider Directory

Locations

400 E 3rd St
#2
Duluth, MN 55805
Phone (218) 786-8319

705 Lundorff Dr
Sandstone, MN 55072
Phone (320) 245-2211

Practitioners & affiliated clinicians

Practitioners 97

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 97

NPI Registry JSON

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684886400000",
    "number": "1972585867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 N 8TH AVE E",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052024",
            "telephone_number": "218-723-1112",
            "fax_number": "218-529-9120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 N 8TH AVE E",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052024",
            "telephone_number": "218-723-1112",
            "fax_number": "218-529-9120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DULUTH GRADUATE MEDICAL EDUCATION COUNCIL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-16",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A",
        "authorized_official_last_name": "PRASAD",
        "authorized_official_first_name": "SHAILENDRA",
        "authorized_official_title_or_position": "BOARD CHAIR",
        "authorized_official_telephone_number": "612-624-7629",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32674900",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "647010600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMN",
            "identifier": "69226FA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Duluth Family Medicine Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Duluth Family Medicine Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.