Individual provider Active NPI

Magdalena Ludmila Pietka, M.D.

  • Family Medicine Physician
  • Mankato, MN
National Provider Identifier
1164605374
Registry record updated Sep 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
51230 Issued in MN
Practice address
1230 E Main St
Mankato, MN 56001-8001
Phone
(507) 625-1811
NPI assigned
Dec 11, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 22, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 19685 MN
Family Medicine Physician 207Q00000X 51230 MN Primary

Addresses

Primary practice location

1230 E Main St
Mankato, MN 56001-8001

Mailing address

1230 E Main St
Mankato, MN 56001-8001
Phone (507) 625-1811

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address magdalenapietka@mklt.allscriptsdirect.net Direct

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
I20090105000432 MN Practitioner - Family Practice 1850454646 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mankato Clinic LTDGroup PAC ID 5597677955, 243 clinicians

Practice addresses (Care Compare)

1230 E Main St
Mankato, MN 56001-5066
Phone (507) 389-8570

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19685MNMDFamily Medicine Physician
51230MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mankato Clinic LTD Family Medicine CurrentSince Oct 1, 2017 Accepting new patients

Locations

800 Medical Center Dr
Fairmont, MN 56031
Phone (507) 238-8100

1025 Marsh St
Mankato, MN 56001
Phone (507) 345-2623

1230 E Main St
Mankato, MN 56001
Phone (507) 389-8502

Interoperability endpoints

  • Direct secure messaging: magdalenapietka@mklt.allscriptsdirect.net

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1197331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600732800000",
    "number": "1164605374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1230 E MAIN ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560018001",
            "telephone_number": "507-625-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 E MAIN ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560018001",
            "telephone_number": "507-625-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIETKA",
        "first_name": "MAGDALENA",
        "middle_name": "LUDMILA",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-11",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "19685",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "51230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "magdalenapietka@mklt.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Mankato Clinic Direct ID, Allscripts Community",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1230 E Main St",
            "city": "Mankato",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560018001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mankato, MN

Sources for this page

Verify at the official NPI Registry.