Mitchell J Mimbach, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

13451 Issued in MN

Practice address

320 East Main St
Crosby, MN 56441

Phone

(218) 546-7000

Fax

(218) 546-4400

NPI assigned

Aug 13, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aitkin Community Hospital IncGroup PAC ID 4981514692, 96 clinicians

Cuyuna Regional Medical CenterGroup PAC ID 9537146550, 133 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cuyuna Regional Medical Center Hospital, Crosby, MN, CCN 241353
• Riverwood Healthcare Center Hospital, Aitkin, MN, CCN 241305

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mmimbach546509@excellian.direct.allina.com

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.

• Aitkin Community Hospital, Inc.

  • Critical Access Hospital
  • Aitkin, MN
  • NPI 1942277835
  Medicare reassignment Care Compare group NPD
• Cuyuna Regional Medical Center

  • Critical Access Hospital
  • Crosby, MN
  • NPI 1538143896
  Medicare reassignment Care Compare group NPD
• Cuyuna Regional Medical Center

  • Family Medicine Physician
  • Longville, MN
  • NPI 1861414518
  Medicare reassignment
• Aitkin Community Hospital, Inc.

  • Community/Retail Pharmacy
  • Aitkin, MN
  • NPI 1497377287
  NPD
• Cuyuna Regional Medical Center

  • Critical Access Hospital Clinic/Center
  • Crosby, MN
  • NPI 1639459282
  NPD

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

• Aitkin Community Hospital, Inc.

  • Critical Access Hospital
  • Aitkin, MN
  • NPI 1942277835
  Care Compare affiliation
• Cuyuna Regional Medical Center

  • Critical Access Hospital
  • Crosby, MN
  • NPI 1538143896
  Care Compare affiliation

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

{
    "created_epoch": "1597276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620691200000",
    "number": "1013528900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 EAST MAIN ST",
            "city": "CROSBY",
            "state": "MN",
            "postal_code": "56441",
            "telephone_number": "218-546-7000",
            "fax_number": "218-546-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 EAST MAIN ST",
            "city": "CROSBY",
            "state": "MN",
            "postal_code": "56441",
            "telephone_number": "218-546-7000",
            "fax_number": "218-546-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIMBACH",
        "first_name": "MITCHELL",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-13",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Howard Marshall McCollister, MD
• Kyle Hogan McCormick
• Alexandra McLaughlin, OTR/L
• Joseph Merck
• Harlie R Metag, APRN, WHNP-BC
• Minnesota Radiology Institute
• Susan M Moen, MD
• Kyle R Moore, D.P.M.
• Jennifer Mount
• Jessica Mae Mudgett

• Physician Assistant in Crosby, MN
• Providers in Crosby, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.