NPIMap

Individual provider Active NPI

Timothy P Michals Jr., M.D.

  • Internal Medicine Physician
  • Marshall, MN
National Provider Identifier
1164620464
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
53817 Issued in MN
Practice address
300 S Bruce St
Marshall, MN 56258-1934
Phone
(507) 532-9661
NPI assigned
Jul 7, 2007
Last updated
Apr 29, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036129518 IL
Internal Medicine Physician 207R00000X 53817 MN Primary
Pediatrics Physician 208000000X 036129518 IL
Pediatrics Physician 208000000X 53817 MN

Addresses

Primary practice location

300 S Bruce St
Marshall, MN 56258-1934

Mailing address

300 S Bruce St
Marshall, MN 56258-1934
Phone (507) 532-9661

Other practice location 1

1420 East College Drive
Affiliated Community Medical Centers
Marshall, MN 56258
Phone (507) 532-9631

Other identifiers 1

IdentifierTypeStateIssuer
1164620464MedicaidMN

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
I20110711000151 MN Practitioner - Pediatric MedicinePractitioner - Internal Medicine 9739367087 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
R Franklin University of Med & Sci/Chicago Medical School, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rural Health Care IncGroup PAC ID 3476447541, shared by 13 NPIs, 156 clinicians
Avera MarshallGroup PAC ID 5799695227, 102 clinicians

Practice addresses (Care Compare)

1216 Ryans Rd
Worthington, MN 56187-1781
Phone (507) 372-6522

1521 Carlson St
Marshall, MN 56258-2626
Phone (507) 473-4800

300 S Bruce St
Marshall, MN 56258-1934
Phone (507) 537-9165

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Rural Health Care, Inc Internal Medicine CurrentSince Jan 1, 2022 Accepting new patients
Avera Marshall CurrentSince Jan 1, 2019 Accepting new patients
Avera Marshall CurrentSince Jan 1, 2019 Accepting new patients
Avera Marshall Current Accepting new patients
Rural Health Care, Inc CurrentSince Jan 1, 2022 Accepting new patients
Avera Marshall Past Accepting new patients

Locations

1521 Carlson St
Marshall, MN 56258
Phone (507) 532-1101

300 S Bruce St
Marshall, MN 56258
Phone (507) 532-9631

300 S Bruce St
Ste 100
Marshall, MN 56258

1216 Ryans Rd
Ste 3
Worthington, MN 56187
Phone (507) 372-6522

Interoperability endpoints

  • Direct secure messaging: timothy.michals@avera.sdhealthlink.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Prairie Home Community CareMarshall, MN, CCN 241507 Hospice Contracted Managing Employee Apr 12, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1183766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1164620464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S BRUCE ST",
            "city": "MARSHALL",
            "state": "MN",
            "postal_code": "562581934",
            "telephone_number": "507-532-9661",
            "fax_number": "507-532-1176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S BRUCE ST",
            "city": "MARSHALL",
            "state": "MN",
            "postal_code": "562581934",
            "telephone_number": "507-532-9661"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1420 East College Drive",
            "address_2": "Affiliated Community Medical Centers",
            "address_purpose": "LOCATION",
            "city": "Marshall",
            "state": "MN",
            "postal_code": "56258",
            "country_code": "US",
            "telephone_number": "507-532-9631",
            "fax_number": "507-532-1176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICHALS",
        "first_name": "TIMOTHY",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-07",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036129518",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "53817",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036129518",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "53817",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1164620464",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marshall, MN

Sources for this page

Verify at the official NPI Registry.