MARK KENNETH WIDSTROM
NPI 1689692758
Obstetrics & Gynecology in Duluth, MN

Active since July 17, 2006PECOS EnrolledAccepts Medicare Assignment
400 E 3RD ST, DULUTH, MN 55805(218) 786-8364 Get Directions Write a Review

NPPES record last updated: May 9, 2011. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Mark Kenneth Widstrom NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARK KENNETH WIDSTROM (NPI 1689692758) is an individual obstetrics & gynecology provider in Duluth, Minnesota, licensed in Minnesota (45497) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS, is affiliated with Essentia Health St Mary's Medical Center, and is a graduate of University Of Minnesota Medical School (1993).

NPPES Registry Identity

NPI1689692758
Entity TypeIndividualMale
Primary Taxonomy207V00000X
Provider Legal NameMARK KENNETH WIDSTROM
Location Address400 E 3RD STDuluth, MN 55805-1951
Mailing Address400 E 3rd StDuluth, MN 55805-1951 · (218) 786-8364
Sole ProprietorNo
Medical School CMSUniversity Of Minnesota Medical SchoolGraduated 1993
Enumeration DateJuly 17, 2006
Last NPPES UpdateMay 9, 2011
NPI 1689692758 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
License Licensed in MN · 45497
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
400 E 3RD ST, Duluth, MN 55805

Other Identifiers 4

Medicaid542440200MN
Medicare UPINH46421
Medicaid34348400WI
Medicare PIN160002214MN

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Mark Kenneth Widstrom is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4789578865
PECOS Enrollment IDI20040210000684
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
15 services14 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Essentia Health St Mary's Medical Center

Acute Care Hospitals · Duluth, MN
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number240002
Location402 East Second StreetDuluth, MN 55805 · St. Louis County
Emergency services Birthing friendly

Essentia Health Duluth

Acute Care Hospitals · Duluth, MN
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number240019
Location502 East Second StreetDuluth, MN 55805 · St. Louis County
Birthing friendly

Essentia Health Deer River

Critical Access Hospitals · Deer River, MN
OwnershipVoluntary non-profit - Private
CMS Certification Number241360
Location115 10th Avenue NortheastDeer River, MN 56636 · Itasca County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55805 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$127.61 typical visit price
range $56.00 – $168.28
Typical copayment $31.90 (range $14.00 – $42.07)
Most-billed visit code 99204
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Anesthetist, Certified Registered
400 E 3RD ST
DULUTH, MN 55805
Internal Medicine (Infectious Disease)
400 E 3RD ST
DULUTH, MN 55805
Nurse Practitioner (Psychiatric/Mental Health)
400 E 3RD ST
DULUTH, MN 55805
Hospitalist
400 E 3RD ST
DULUTH, MN 55805
Radiology (Diagnostic Radiology)
400 E 3RD ST
DULUTH, MN 55805
Internal Medicine (Cardiovascular Disease)
400 E 3RD ST
DULUTH, MN 55805
Clinical Nurse Specialist (Medical-Surgical)
400 E 3RD ST
DULUTH, MN 55805
Internal Medicine
400 E 3RD ST
DULUTH, MN 55805

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mark Widstrom's NPI number?

The NPI number for Mark Widstrom is 1689692758. It was assigned to this individual provider in the NPPES registry on July 17, 2006.

Where is Mark Widstrom located?

Mark Widstrom practices at 400 E 3rd St, Duluth, MN 55805. The listed phone number is (218) 786-8364.

What is Mark Widstrom's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Is Mark Widstrom enrolled in Medicare?

Yes. Mark Widstrom is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Mark Widstrom accept?

Health plans from HealthPartners, Medica, Sanford Health Plan and Security Health Plan list Mark Widstrom as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Mark Widstrom affiliated with any hospitals?

According to CMS data, Mark Widstrom is affiliated with Essentia Health St Mary's Medical Center, Essentia Health Duluth and Essentia Health Deer River.

When was this NPI record last updated?

The NPPES record for Mark Widstrom was last updated on May 9, 2011. NPI Profile syncs with the weekly NPPES data releases published by CMS.