NPIMap

Individual provider Active NPI

Daniel Watson

  • Otolaryngology Physician
  • St Louis Park, MN
National Provider Identifier
1083691844
Registry record updated Oct 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
35994 Issued in MN
Practice address
3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone
(952) 993-3250
NPI assigned
Dec 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 35994 MN Primary

Addresses

Primary practice location

3800 Park Nicollet Blvd
St Louis Park, MN 55416-2527

Mailing address

6465 Wayzata Blvd
Ste 315
Minneapolis, MN 55426-1728

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
I20100202000580 MN Practitioner - Otolaryngology 9133262942 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Minnesota Medical School, 1991
Medicare assignment
May accept Medicare assignment
Group practices
Mankato Clinic LTDGroup PAC ID 5597677955, 243 clinicians
CCM HealthGroup PAC ID 4284539453, 69 clinicians

Practice addresses (Care Compare)

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

1230 Main St E
PO Box 8674
Mankato, MN 56002-8674
Phone (507) 625-1811

1411 Premier Dr
Mankato, MN 56001-6076
Phone (507) 388-6000

1421 Premier Dr
Mankato, MN 56001-6076
Phone (507) 385-4000

1431 Premier Dr
Mankato, MN 56001-6076
Phone (507) 386-6750

1431 Premier Dr MRI Dept
Orthopaedic and Fracture Clinic
Mankato, MN 56001-6076
Phone (507) 386-6750

1900 Sunrise Dr
Saint Peter, MN 56082-5376
Phone (507) 931-2200

824 N 11TH St
Montevideo, MN 56265-1629
Phone (320) 269-8877

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35994MNMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mankato Clinic LTD Otolaryngology CurrentSince Mar 1, 2024 Accepting new patients
Park Nicollet Clinic Current Accepting new patients
CCM Health CurrentSince Jul 30, 2015 Accepting new patients
Park Nicollet Clinic CurrentSince Jun 3, 2002 Accepting new patients
CCM Health CurrentSince Jul 30, 2015 Accepting new patients
CCM Health Past Accepting new patients
CCM Health Past Accepting new patients

Locations

1421 Premier Dr
Mankato, MN 56001
Phone (507) 385-4000

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

824 N 11th St
Montevideo, MN 56265
Phone (320) 269-8877

3800 Park Nicollet Blvd
St Louis Park, MN 55416
Phone (952) 993-1000

Interoperability endpoints

  • Direct secure messaging: dwatson482459@direct.centracare.com
  • Direct secure messaging: danielwatson@mklt.allscriptsdirect.net

Organizations & group practices 7

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 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318377600000",
    "number": "1083691844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6465 WAYZATA BLVD",
            "address_2": "STE 315",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554261728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 PARK NICOLLET BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554162527",
            "telephone_number": "952-993-3250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "DANIEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-22",
        "last_updated": "2011-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MN",
            "license": "35994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.