Individual provider Active NPI

Timothy Michael Sitton, MD

  • Anesthesiology Physician
  • Edina, MN
National Provider Identifier
1043622186
Registry record updated Dec 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
63654 Issued in MN
Practice address
6401 France Ave S
Edina, MN 55435-2104
Phone
(763) 559-3779
Fax
(763) 450-3986
NPI assigned
May 23, 2014
Last updated
Dec 12, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X MI
Anesthesiology Physician 207L00000X 63654 MN Primary

Addresses

Primary practice location

6401 France Ave S
Edina, MN 55435-2104

Mailing address

14700 28TH Ave N Ste 20
Plymouth, MN 55447-4876
Phone (763) 559-3779

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
I20180803002522 MN Practitioner - Anesthesiology 0941517486 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Creighton University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southdale Anesthesiologists LLCGroup PAC ID 6709842461, 62 clinicians

Practice addresses (Care Compare)

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
63654MNMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southdale Anesthesiologists, LLC Single Specialty CurrentSince Aug 6, 2018 Accepting new patients

Locations

6401 France Ave S
Minneapolis, MN 55435
Phone (952) 920-8477

14700 28th Ave N
Ste 20
Plymouth, MN 55447
Phone (612) 559-3779

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1400803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544572800000",
    "number": "1043622186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14700 28TH AVE N STE 20",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554474876",
            "telephone_number": "763-559-3779",
            "fax_number": "763-450-3986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6401 FRANCE AVE S",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352104",
            "telephone_number": "763-559-3779",
            "fax_number": "763-450-3986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SITTON",
        "first_name": "TIMOTHY",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-05-23",
        "last_updated": "2018-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MN",
            "license": "63654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

Verify at the official NPI Registry.