Individual provider Active NPI

Mary Therese Klinker, M.D.

  • Family Medicine Physician
  • Little Falls, MN
National Provider Identifier
1104841295
Registry record updated Nov 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
37413 Issued in MN
Practice address
811 2ND St SE
Suite a
Little Falls, MN 56345-3559
Phone
(320) 631-7000
Fax
(320) 632-0534
NPI assigned
Jul 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2012

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 37413 MN Primary

Addresses

Primary practice location

811 2ND St SE
Suite a
Little Falls, MN 56345-3559

Mailing address

811 2ND St SE
Suite a
Little Falls, MN 56345-3559
Phone (320) 631-7000

Other identifiers 8

IdentifierTypeStateIssuer
0101031OtherMEDICA
A015OtherMNTRICARE
NA9231013065OtherPREFERRED ONE
102868C736OtherMNUCARE MINNESOTA
21627OtherAMERICA'S PPO
5T131KLOtherMNBCBS OF MINNESOTA
981819700MedicaidMN
HP264B2OtherHEALTH PARTNERS

Other names 1

  • Ms. Mary Therese Miller Former name

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
I20050110000397 MN Practitioner - Family Practice 8022066794 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5519MNMDChiropractor
37413MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Unity Family Healthcare CurrentSince Sep 10, 2010 Accepting new patients
Unity Family Healthcare Current Accepting new patients
Unity Family Healthcare Family Medicine CurrentSince Sep 10, 2010 Accepting new patients
Unity Family Healthcare Current Accepting new patients

Locations

7892 Solutions Ctr
Chicago, IL 60677

815 2nd St SE
Little Falls, MN 56345
Phone (320) 632-5441

811 2nd St SE
Ste A
Little Falls, MN 56345
Phone (320) 631-7000

4784 Amber Valley Pkwy S
Fargo, ND 58104

Interoperability endpoints

  • Direct secure messaging: mklinker196295@direct.centracare.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352246400000",
    "number": "1104841295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 2ND ST SE",
            "address_2": "SUITE A",
            "city": "LITTLE FALLS",
            "state": "MN",
            "postal_code": "563453559",
            "telephone_number": "320-631-7000",
            "fax_number": "320-632-0534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 2ND ST SE",
            "address_2": "SUITE A",
            "city": "LITTLE FALLS",
            "state": "MN",
            "postal_code": "563453559",
            "telephone_number": "320-631-7000",
            "fax_number": "320-632-0534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLINKER",
        "first_name": "MARY",
        "middle_name": "THERESE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2012-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "37413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "0101031",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "A015",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "NA9231013065",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MINNESOTA",
            "identifier": "102868C736",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICA'S PPO",
            "identifier": "21627",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MINNESOTA",
            "identifier": "5T131KL",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "981819700",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP264B2",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "MILLER",
            "middle_name": "THERESE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Little Falls, MN

Sources for this page

Verify at the official NPI Registry.