Individual provider Active NPI

Timothy W. Huisken, MD

  • Surgery Physician
  • Mankato, MN
National Provider Identifier
1013008366
Registry record updated Aug 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
40471 Issued in MN
Practice address
1230 E Main St
Mankato, MN 56001
Phone
(507) 625-1811
NPI assigned
Sep 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4321 SD
Surgery Physician 208600000X 40471 MN Primary

Addresses

Primary practice location

1230 E Main St
Mankato, MN 56001

Mailing address

1230 E Main St
Mankato, MN 56001-5066
Phone (507) 625-1811

Other practice location 1

1100 Wilford Hall Loop Bldg 4554
Jbsa Lackland, TX 78236-5638
Phone (210) 292-6225

Other practice location 2

3551 Roger Brooke Dr
Attn: McHe-ZQQ
JBSA Ft Sam Houston, TX 78234-4504
Phone (210) 916-2338

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address timothyhuisken@mklt.allscriptsdirect.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190403001786 MN Practitioner - General Surgery 4789822404 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Minnesota Medical School, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mankato Clinic LTDGroup PAC ID 5597677955, 243 clinicians

Practice addresses (Care Compare)

1230 E Main St
Mankato, MN 56001-5066
Phone (507) 389-8509

Hospital & facility affiliations

  • Mayo Clinic Health System - Mankato Hospital, Mankato, MN, CCN 240093

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Mastectomy1-10
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
40471MNMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mankato Clinic LTD Surgery CurrentSince Apr 1, 2019 Accepting new patients

Locations

1230 E Main St
Mankato, MN 56001
Phone (507) 389-8502

Interoperability endpoints

  • Direct secure messaging: timothyhuisken@mklt.allscriptsdirect.net

Organizations & group practices 1

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596758400000",
    "number": "1013008366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 E MAIN ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015066",
            "telephone_number": "507-625-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 E MAIN ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "56001",
            "telephone_number": "507-625-1811"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Wilford Hall Loop Bldg 4554",
            "address_purpose": "LOCATION",
            "city": "Jbsa Lackland",
            "state": "TX",
            "postal_code": "782365638",
            "country_code": "US",
            "telephone_number": "210-292-6225",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3551 ROGER BROOKE DR",
            "address_2": "ATTN: MCHE-ZQQ",
            "address_purpose": "LOCATION",
            "city": "JBSA Ft Sam Houston",
            "state": "TX",
            "postal_code": "782344504",
            "country_code": "US",
            "telephone_number": "210-916-2338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUISKEN",
        "first_name": "TIMOTHY",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2020-08-07",
        "certification_date": "2020-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SD",
            "license": "4321",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MN",
            "license": "40471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "timothyhuisken@mklt.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Mankato Clinic Direct ID, Allscripts Community",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1230 E Main St",
            "city": "Mankato",
            "state": "MN",
            "country_code": "US",
            "postal_code": "56001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mankato, MN

Sources for this page

Verify at the official NPI Registry.