NPIMap

Individual provider Active NPI

Brad Jacob Davis

  • Anatomic Pathology & Clinical Pathology Physician
  • Duluth, MN
National Provider Identifier
1992736268
Registry record updated May 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
44532 Issued in MN
Practice address
400 E 3Rd St
Duluth, MN 55805-1951
Phone
(218) 786-8364
NPI assigned
Jul 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology (Pathology) Physician 207ZH0000X 44532 MN
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 44532 MN Primary

Addresses

Primary practice location

400 E 3Rd St
Duluth, MN 55805-1951

Mailing address

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

Other identifiers 1

IdentifierTypeStateIssuer
321314500MedicaidMN

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
I20040210000626 MN Practitioner - Pathology 6406740570 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

402 E 2ND St
Duluth, MN 55805-1906
Phone (218) 786-4000

Hospital & facility affiliations

  • Essentia Health Duluth Hospital, Duluth, MN, CCN 240019
  • Essentia Health St Mary'S Medical Center Hospital, Duluth, MN, CCN 240002
  • Essentia Health St Joseph'S Medical Center Hospital, Brainerd, MN, CCN 240075
  • Essentia Health Hospital, Fargo, ND, CCN 350070
  • St Marys Hospital Superior Hospital, Superior, WI, CCN 521329

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
44532MNMDHematology (Pathology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph'S Medical Center Current Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
Essentia Health Virginia, LLC CurrentSince Dec 1, 2013 Accepting new patients
St. Joseph'S Medical Center CurrentSince Apr 16, 2018 Accepting new patients
St Joseph'S Medical Center CurrentSince Apr 16, 2018 Accepting new patients
The Duluth Clinic, LTD CurrentSince Feb 1, 2004 Accepting new patients
Essentia Health Virginia, LLC CurrentSince Dec 1, 2013 Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients

Locations

523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

1101 9th St N
Virginia, MN 55792
Phone (218) 305-0000

901 9th St N
Virginia, MN 55792
Phone (218) 741-3340

11134 N State Road 77
Hayward, WI 54843
Phone (715) 634-5505

Organizations & group practices 8

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305763200000",
    "number": "1992736268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "BRAD",
        "middle_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2011-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZH0000X",
            "taxonomy_group": "",
            "desc": "Pathology, Hematology",
            "state": "MN",
            "license": "44532",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MN",
            "license": "44532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "321314500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.