NPIMap

Individual provider Active NPI

Sara Johanna Mitlyng, M.D.

  • Family Medicine Physician
  • St Louis Park, MN
National Provider Identifier
1013182005
Registry record updated Feb 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
48708 Issued in MN
Practice address
6600 Excelsior Blvd
Suite 100
St Louis Park, MN 55426-4744
Phone
(952) 993-7700
NPI assigned
Apr 29, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 48708 MN Primary

Addresses

Primary practice location

6600 Excelsior Blvd
Suite 100
St Louis Park, MN 55426-4744

Mailing address

19685 Highway 7
Excelsior, MN 55331-7516
Phone (952) 993-2900

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
I20081105000357 MN Practitioner - Family Practice 9133288194 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

15111 Twelve Oaks Ctr Dr
Minnetonka, MN 55305-5201
Phone (952) 993-4500

250 Central Ave N
Wayzata, MN 55391-1206
Phone (952) 993-3123

300 Lake Dr E
Chanhassen, MN 55317-9302
Phone (952) 993-4300

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

Hospital & facility affiliations

  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Family Medicine Current Accepting new patients
Park Nicollet Clinic Family Medicine CurrentSince Oct 1, 2008 Accepting new patients
Park Nicollet Clinic Family Medicine CurrentSince Oct 1, 2008 Accepting new patients

Locations

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

19685 Highway 7
Shorewood, MN 55331
Phone (952) 993-2900

6600 Excelsior Blvd
Ste 100
St Louis Park, MN 55426
Phone (952) 993-7700

Interoperability endpoints

  • Direct secure messaging: smitlyng157195@direct.healthpartners.com

Organizations & group practices 3

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 6

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": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360540800000",
    "number": "1013182005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19685 HIGHWAY 7",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553317516",
            "telephone_number": "952-993-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 EXCELSIOR BLVD",
            "address_2": "SUITE 100",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264744",
            "telephone_number": "952-993-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITLYNG",
        "first_name": "SARA",
        "middle_name": "JOHANNA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-29",
        "last_updated": "2013-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "48708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.